Digital Marketing
Strata Health GroupHeadquarters
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Complaints
This profile includes complaints for Strata Health Group's headquarters and its corporate-owned locations. To view all corporate locations, see
Customer Complaints Summary
- 157 total complaints in the last 3 years.
- 27 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe complaint text that is displayed might not represent all complaints filed with BBB. 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.
Initial Complaint
Date:03/30/2025
Type:Product IssuesStatus:ResolvedMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
My husband attempted to buy health insurance for me on March 17 for $422.90. When we discovered it was not truly insurance that he purchased, I called on March 19 for a cancellation of policy and a refund of our money. After speaking to 3 representatives, they refunded $306, but said that the remaining balance that was owed to us was an enrollment fee. My understanding is that there is a 30 day window in which to review insurance policies. They told me we could email them, which I did on 3/20 at **************************************************************************************. However, when I had not heard from them, I attempted to reach out to them the following week at the same address. The email bounced back to me with this explanation: "Recipient address rejected: Access denied." I would like the remaining $116.90 credited to us.Business Response
Date: 04/01/2025
Ms. ******************** you for making Adroit Health Group aware of your dissatisfaction with the Good Health that you purchased through our company. We are also dismayed to learn of the problems you encountered in trying to cancel the account. In this response, we hope to address both issues that you have raised.
First, with regards to the Good Health product you purchased. We respectfully disagree that the Good Health product is not insurance. Rather, this particular plan is a Minimum Essential Coverage plan. While this type of plan is certainly not comprehensive insurance coverage nor major medical insurance, it still covers the full array of benefits required of a minimum essential coverage plan. On page two of your signed Enrollment Agreement, it specifically states in bolded and highlighted text: This group health plan is limited to covering preventive and wellness services as required by the Patient Protection and *************** Act as well as other benefits noted in the Summary Plan Description, which describes the benefits covered by the Plan and how these benefits are covered, including information on copays, deductibles, and limitations. Immediately following this emphasized disclosure, the following important terms are listed:
- The Good Health benefit plans have a limited schedule of benefits and will only
pay for those items specifically listed in the schedule of benefits.
- The Good Health benefit plans are not major medical insurance and should not be
viewed as a substitute for major medical coverage.
- The Good Health benefit plans do not comply with the *************** Act (ACA),
otherwise known as "Obamacare."
We regret that you found these benefits to not satisfactorily address you and your familys needs. Nevertheless, you were well within your rights to change your mind and cancel the account. You are also correct that our Company policy is to afford customers a full thirty (30) day period to review the product and cancel for any reason if dissatisfied. It does appear that you attempted to exercise this right in a timely fashion. Your request should have immediately been honored. We are sorry that this was not the case.
As you have stated in your complaint, it appears you contacted the sales agency, and not Adroit Health Group directly, in attempting to cancel the account. The @************************************ e-mail address you cited is connected only with the sales agency and not our company, and it appears that your telephone inquiries also went to the sales agency. Regardless, you should have been refunded the full amount at that time by the sales agency.
We have contacted the sales agency and demanded that they investigate the customer service problem and take steps to address the problems going forward. In the meantime, I asked Adroits ************************** to confirm that a full cancellation of your account and all products has, in fact, occurred. I have also directed our ****************** to process a full refund of all charges. I am pleased to report that all of these open items have now been addressed. Copies of the cancellation confirmation notice and the refund receipts for all your charges are appended to this response for your records.
If you encounter any further problems, please feel free to contact Adroits ********************* at any time. You may reach us at *********************************************. Again, please accept our sincere apologies for the manner in which this was handled.
Best regards,
******* *****
General Counsel & Chief Compliance Officer
Adroit Health Group, LLCCustomer Answer
Date: 04/02/2025
I have reviewed the business response and accept this resolution. I understand what was said in your letter that what my husband purchased was indeed insurance. However, he was led to believe it was major medical, which, as you explained, it was not. The full amount has been refunded, and we appreciate the quick and prompt action you took. We are thankful you will be looking into this with your sales' team since they represent your business. It would be great if this doesn't happen to others.
I would like to thank the BBB for representing us in this matter. I know this isn't always the case, but our complaint was resolved quickly once they got involved.
Initial Complaint
Date:03/20/2025
Type:Service or Repair IssuesStatus:ResolvedMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
ADROIT HEALTH GROUP said they were enrolling me in an AETNA health care insurance program. But this company just charge me $261.95 for nothing. It is a scam. I tried calling them to ask them to refund me my money and they just hanged up. I file a claim with ********************* my bank and they cannot give me my money back because they also agree that it was a scam and they do not cover scams. I have attached the letter that ***** fargo sent me.Business Response
Date: 03/27/2025
Ms. *********,
Thank you for making Adroit Health Group aware of the problems you encountered with the sale and attempted cancellation of your plan. Our records show that you were enrolled in a **************** Medical Plan, which is underwritten by ****************** Security Life Insurance Company and not *****. It appears that the miscommunication may have arisen out of the fact that certain products do utilize an ***** provider network, but this is different than their being an Aetna plan--which they are not. I apologize if this was communicated in a misleading manner. Moreover, the manner in which your cancellation attempt was handled is not acceptable and you should have never been hung up on by anyone. Please know that the telephone number you contacted was not an Adroit *************************** number, and it appears to be a telephone number associated with the sales agency who sold you the products in question. These agencies and their agents are not employees of Adroit Health Group, and instead are solely third party contractors. I appreciate your speaking with me yesterday and providing me additional information about what transpires. We are conducting an internal review and will take appropriate disciplinary actions. In the meantime, I have directed Adroit's ****************** to process a cancellation of your account and issue you a full refund of all charges. I am attaching to this response a copy of the receipt evidencing this refund. Depending on your financial institution, it may take up to five (5) business days before the refund is reflected on your bank statement. If you have not seen the refund hit your account by early next week, please feel free to contact me again at ******************************** and I will gladly follow up for you. Please accept my sincerest apologies for the problems you experienced.
Best regards,
******* *****
General Counsel & Chief Compliance Officer
Adroit Health Group, LLC
Customer Answer
Date: 03/27/2025
I have reviewed the business response and accept this resolution. However, they are very misleading. Even though I appreciate they refund me the money I still believe they are a scam because they do not enroll you in any health insurance plan.Initial Complaint
Date:03/04/2025
Type:Sales and Advertising IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I got insurance through this company. Not my medication, not one Doctor's visit for myself or my husband has ever been paid, not even $10 every time I call them. They said my provider was in the network, but however, I'm stuck with paying high medical bills. Pay full calls for all my medication and also pay them every month.Two hundred and seventy dollarsBusiness Response
Date: 03/12/2025
We have been unable to locate any account corresponding to this consumer under either the name, address, telephone number, or e-mail address provided with the complaint. We believe this consumer could be listed under a different name or as a dependent under another person's account. We have sent multiple messages to the complainant at the e-mail address listed on the BBB complaint ************************* asking for her to provide the account number about which she is complaining. Copies of all e-mail messages sent to this complainant are enclosed for reference. To date, we have received no response. If these messages are being directed to the complainant's junk e-mail account and she is able to view this response, she is certainly free to contact me directly at ********************************
In the event this consumer provides additional details about the account, we will respond directly to her concerns in a timely manner. We apologize for the inconvenience.
Best regards,
******* *****, General Counsel & Chief Compliance Officer
Initial Complaint
Date:03/01/2025
Type:Sales and Advertising IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Insurance scam - false advertising with coverage and in network providersBusiness Response
Date: 03/04/2025
Thank you for making our company aware of Ms. **** dissatisfaction with the *** Health product that was purchased through our enrollment and billing platforms. Our records show that Ms. ** purchased a standard minimum essential coverage plan issued by *** Health on July 01, 2024, with an effective date of August 01, 2024. However, it appears that she cancelled the plan on September 09, 2024.
Please be advised that our Company does not engage in any direct-to-consumer sales. Rather, our Company functions solely as an independent marketing organization that makes certain insurance and non-insurance products available for sale by third-party independent contractors through our Companys enrollment and billing platforms. In this transaction, Ms. ** worked with a sales producer who is not an employee of our Company and whose agency is not owned or operated or otherwise affiliated with our Company. They are totally separate and distinct entities who do contract with our Company to access our platforms. Our agreements with these sales producers require that they provide accurate information concerning product coverages, exclusions and limitations, and associated costs. To the extent Ms. ** believes that the coverage and network components of her *** Health Plan was misrepresented to you, we sincerely apologize.
Because we were not privy to the discussions that she may have had with her third-party sales producer on July 01, 2024, we are unable to comment on the accuracy of his statements. However, in order to ensure that customers transacting business on our platforms fully understand the terms and conditions of their sale, we require that all transactions be consummated through the presentation, review, and execution of a written Enrollment Agreement. In this particular case, Ms. ** received your Enrollment Agreement on July 01, 2024, and signed it that same date at 2:13 p.m. Your attention is called to the following express disclosures contained in this signed Enrollment Agreement:
1. The *** plan IS NOT A MAJOR MEDICAL OR COMPREHENSIVE COVERAGE. The *** plan covers the preventive health services required by the **** 2713 (a) without any cost-sharing requirements. (** Enrollment Agreement, 07/01/2024, p. 3, original underlined for emphasis, capitalized emphasis added)
2. All covered IN-NETWORK PREVENTIVE SERVICES WILL BE 100% COVERED by the Plan. (** Enrollment Agreement, 07/01/2024, p. 3, original underlined for emphasis, capitalized emphasis added)
3. OUT OF NETWORK SERVICES WILL NOT BE COVERED unless otherwise specified, and the Plan Member will owe 100% of the cost of these services. (** Enrollment Agreement, 07/01/2024, p. 3, original underlined for emphasis, capitalized emphasis added)
4. NONE OF THE PREVENTIVE HEALTH SERVICES ARE COVERED IF THEY ARE PROVIDED AT A HOSPITAL. (** Enrollment Agreement, 07/01/2024, p. 3, original underlined for emphasis, capitalized emphasis added)
5. THIS PLAN DOES NOT COVER BENEFITS UNLESS LISTED IN THE SCHEDULE OF BENEFITS, SO PLEASE REVIEW THAT LIST CAREFULLY. (** Enrollment Agreement, 07/01/2024, p. 3, original underlined for emphasis, capitalized emphasis added)
6. THIS GROUP HEALTH PLAN IS LIMITED TO COVERING PREVENTIVE AND WELLNESS SERVICES AS REQUIRED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AS WELL AS OTHER BENEFITS NOTED IN THE SCHEDULE OF BENEFITS, WHICH DESCRIBES THE BENEFITS COVERED BY THE PLAN AND HOW THESE BENEFITS ARE COVERED, INCLUDING INFORMATION ON COPAYS, DEDUCTIBLES, AND LIMITATIONS. ***/VP LP sponsors this group health plan. (** Enrollment Agreement, 07/01/2024, pp. 3-4, original underlined for emphasis, capitalized emphasis added)
7. The *** plan includes a supplemental benefit for hospitalization confinement payable at $1,000 a day for up to 5 days. Neonatal ************** (NICU) is not covered. This supplemental hospitalization confinement benefit component contains a pre-existing condition limitation for an illness, injury, or condition, for which medical advice, diagnosis, care, or treatment was recommended to, or received by, a covered person or that manifested symptoms which would cause an ordinarily prudent person to seek diagnosis or treatment within 12 months immediately preceding the effective date the covered person became insured under the Plan. This exclusion will apply for the first 12-months the Plan is in force. (** Enrollment Agreement, 07/01/2024, p. 4)
8. Your Plan allows you to enjoy significant savings through the First Health Network, which can significantly reduce your out-of-pocket expenses. OUT OF NETWORK SERVICES ARE NOT COVERED. (** Enrollment Agreement, 07/01/2024, p. 4, emphasis added)
9. You understand that the *** benefit plans are NOT MAJOR MEDICAL INSURANCE AND SHOULD NOT BE VIEWED AS A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. The *** plans DO NOT COMPLY WITH THE AFFORDABLE CARE ACT (ACA), otherwise known as Obamacare. (** Enrollment Agreement, 07/01/2024, p. 6, emphasis added)
10. THE *** PLANS HAVE A LIMITED SCHEDULE OF BENEFITS AND WILL ONLY PAY FOR THOSE ITEMS SPECIFICALLY LISTED IN THE SCHEDULE OF BENEFITS. (** Enrollment Agreement, 07/01/2024, p. 6, emphasis added)
11. The *** Plans have a 30-DAY WAITING PERIOD for sickness before coverage is provided. (** Enrollment Agreement, 07/01/2024, p. 6, emphasis added)
12. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (** Enrollment Agreement, 07/01/2024, p. 6, emphasis original)
13. [x| By electronically acknowledging this authorization, I acknowledge that I have read, agree, and consent to the terms and conditions set forth in this agreement ,.. (** Enrollment Agreement, 07/01/2024, p. 7)
14. I agree that I have a full and complete understanding of the products for which I am applying. (** Enrollment Agreement, 07/01/2024, p. 15)
15. By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. (** Enrollment Agreement, 07/01/2024, p. 15)
Immediately upon execution of your Enrollment Agreement you were provided a Welcome E-mail that advised how you could use our electronic Member Portal to access your plan documents, including your *** Health Schedule of Benefits. In particular, this e-mail noted, You have 24/7 access to important product information and program documents via the Member Portal. Your login instructions are listed below. Please register to use the Member Portal as soon as possible using the link provided. NOTE: Most product documents and important information is only provided electronically from within the member portal. A copy of the Welcome E-mail and Portal Notification is appended to this response for reference. We note that our system records indicate that you did, in fact, open and read this e-mail on July 01, 2024, at 2:16:23 p.m. Our system has also recorded that you accessed your Member Portal on multiple occasions thereby indicating you had both the knowledge of and access to the portal where you could have and should have reviewed the *** Health Schedule of Benefits which you were admonished to do in the Enrollment Agreement.
In sum, Ms. ** received ample written disclosures concerning the limited nature of the *** Health Plan you purchased. She was also advised to review the Schedule of Benefits for a detailed description of the coverages. All of these disclosures were accurate and reflected the full scope of her plan. While it is unclear what if anything the third-party sales producer may have told her about specific health care providers, we note that a providers participation in any network is dynamic and subject to change from time to time. Ms. ** also had accurate information about the First Health Network and how to verify the status of a provider, which was made available to her with your fulfillment materials (including your member identification card) through the Electronic Member Portal. We should note that the fulfillment materials separately include a number of the same disclosures excerpted above. A copy of these fulfillment materials is also enclosed with our response.
Furthermore, as noted on page 4 of your Enrollment Agreement, Ms. ** was entitled to a full thirty (30) day period to review the plan and plan materials, and if she was dissatisfied for any reason, she could cancel during that time period and receive a full refund. Her cancellation on. September 09, 2024, occurred outside this thirty-day window, and for this reason, she is unfortunately not eligible for a refund.
Our Company regrets that Ms. ** did not find the *** Health Plan to satisfactorily meet her insurance needs. However, based on the above and foregoing, we believe she was fully informed of the coverages and network requirements associated with this plan and there is no evidence that she was subjected to a scam as has been alleged. Additionally, Ms. ** had a thirty-day period to review the plan and cancel to receive a refund, but you failed to exercise this right in a timely manner. As a result, it is our belief that that Ms. ** was treated fairly and in full compliance with applicable law.Thank you for affording us an opportunity to review and respond to this complaint.
Sincerely,
******* *****
General Counsel & Chief Compliance OfficerCustomer Answer
Date: 03/04/2025
I am rejecting this response because: i believe third party sales platform receives commissions fees from promoting your health plan which was advertised inaccurately during the process by themBusiness Response
Date: 03/10/2025
Thank you for these additional comments. We must reiterate that accurate information concerning all purchased products, inclusive of coverages, limitations and exclusions, and costs was indeed provided to Ms. ** at the time of sale in her Enrollment Agreement. This was the sole point of contact that our Company had with the consumer concerning the details of your purchase. A detailed summation of those various disclosuresfifteen in totalhas been previously provided in response to this complaint.
Further, information concerning our Company and its role has previously been provided to Ms. ** at the time of sale. Reference is made to the Welcome E-mail sent to the consumer on the date of enrollment that spells out our role in providing benefit and enrollment administration and billing services, as well as that of the sales agent responsible for the sale (who you are reminded is not an employee or affiliate of our Company) and the carrier or provider who is responsible for the payment of claims and benefits (again, who you are reminded is not an affiliate of our Company).
In short, Ms. ** was, in fact, provided accurate information concerning the products at the time of sale by our Company and she was afforded a full thirty-day period to consider her purchase and cancel in order to receive a refund.Customer Answer
Date: 03/10/2025
I am rejecting this responseInitial Complaint
Date:02/24/2025
Type:Product IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I paid Strata Health Group $339.90 on February 6, 2024 for a medical benefits plan to include my specific medicines. I can't find a pharmacy to accept insurance and all the numbers for customer service are not working. I would like a refund.Business Response
Date: 02/26/2025
Mr. ********************* you for making our company aware of your dissatisfaction with your recent purchase. We regret that you have been unable to locate a pharmacy that will accept the prescription discount benefit.
Our records show that you purchased this plan from your agent of record at Legacy Health Insurance Advisors, on February 05, 2024. As detailed on page 5 of your Enrollment Agreement, you are eligible to cancel your account during the first thirty (30) days and receive a refund of charges. Based on your request in your BBB complaint, we processed the cancellation of your account as of February 25, 2025. A copy of the cancellation notice is appended to this response for your records. Additionally, we processed a refund of all charges in the total amount of $339.90 on February 25, 2025. A copy of the receipt evidencing this refund is also enclosed with this response. Depending on your financial institution, it may take up to five (5) business days before the refund is posted onto your bank or credit card statement. If you have not seen the refund hit your account by this time next week, please feel free to contact our ********************* at *********************************************, and we will be happy to follow up for you.
Best regards,
******* *****
General Counsel & Chief Compliance OfficerInitial Complaint
Date:12/19/2024
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I was sold health insurance with false information regarding coverage. I was rushed through the whole process. I was totally unaware that in these documents it stated I could not dispute the transaction. I filed a dispute with my bank but they were provided documentation on why. This transaction took half of my monthly social security amount. I was taken advantage of and would like my money returned to me.Business Response
Date: 12/20/2024
Dear Ms. ********************** you for making our company aware of your refund issues. We appreciate the opportunity to review and address your concerns. Our records indicate that you purchased a limited medical plan and a dental and vision savings plan through Adroit Health Group (Adroit) on October 02, 2024, and your policy was cancelled on November 08, 2024. It is unclear what false information you believe you were provided concerning the products you were buying. However, we should point out that the sales producer with whom you dealt is not an employee of our company. Rather, Adroit is an independent marketing organization that makes certain insurance and non-insurance products available for sale by licensed, third-party sales producers through our billing and enrollment. The sales producers are independent contractors who generally (although not always) makes sales for a number of agencies, including Adroit. Because we were not privy to the discussions that you had with your sales producer, we are not in a position to address the accuracy of the representations that may have been made. However, Adroit requires that all sales on our platform be consummated through the presentation, review, and execution of a written Enrollment Agreement. This Enrollment Agreement contains important disclosures of all material terms of the sale, specifically including but not limited to details concerning product coverages, exclusions and limitations, and associated costs. You received and signed your Enrollment Agreement on October 02. 2024, at 6:43 p.m., from a computer IP address corresponding to your physical location. The provisions of the written Enrollment Agreement that you reviewed and signed accurately describe all terms of the account, including but not limited to the product coverages and/or other benefits.
Based on the fact that your complaint only references dissatisfaction with the cost of your products, we should point out that accurate disclosures of each products cost was provided to you in multiple places in your Enrollment Agreement. Specifically, the accurate cost disclosures appear on pages 1, 5, 7, 10, and 11. Further, a summary of all product costs appears at the end of your agreement immediately above where you physically signed the contract.
With regard to your claims about being told you cannot dispute the transaction, we should clarify that you agreed in your Enrollment Agreement that you would not commence a chargeback dispute with your financial institution. Your attention is called to the following provision from your signed Enrollment Agreement:You certify that you are an authorized user of this credit card, debit card, or bank account. You agree that you will not dispute the scheduled payments with your credit card company or bank provided the transactions correspond to the terms indicated in this authorization. You agree that if any such charge is dishonored, whether with or without cause and whether intentionally or inadvertently, Adroit Health Group, the carrier, the association, the service provider, the bank or credit card company shall be under no liability whatsoever, even though it may result in forfeiture of your plan or membership. (******** Enrollment Agreement, 10/04/2024, p. 2)
As you attested upon your signature of the Enrollment Agreement, you acknowledge that I have read and agree to the terms and conditions set forth in this agreement. Therefore, per the terms of your contract, by commencing the chargeback dispute that ***** our company, you have forfeited any right to a refund and our Company has no further liability towards you.
Our hope is that when customers have an issue, they will be able to amicably resolve the problems with our *************** Department. Unfortunately, when a chargeback dispute is commenced with ones bank or credit card company, as occurred in this instance, it completely takes the transaction out of our control and makes it impossible to make any adjustments to the charges while the financial institution reviews the dispute. This unnecessarily delays any resolution of the problem. In such an occurrence, even if we were inclined to issue you a refund, there is simply nothing for us to refund as the charge has essentially been placed on hold by the financial institution while they review your claim. This is precisely what has transpired here.
After reviewing your account, although it appears you are outside our 30-day refund window, Adroit is willing to provide you a refund of your charges as soon as we are able. However, again, we are unable to issue a refund at this time due to your chargeback dispute taking the transaction out of our control. Therefore, in the likely event that your financial institution determines that the charges were appropriate and it upholds the transaction and releases the hold on the charge, we will be happy to issue you a refund at that time. This commitment to issue a refund should not be construed, interpreted, or deemed to be an admission of any fault or liability on the part of Adroit Health Group, LLC, or its affiliates, and instead is a gesture of good will to a valued customer and serves solely as a transaction and compromise of a disputed claim.
Further, this date I have been advised by Adroits Billing Department that the dispute has not been adjudicated and remains pending. I have asked them to continue monitoring the chargeback and if/when your dispute is denied, they have been asked to issue you a refund. If your chargeback dispute is approved, then obviously there will be no need to issue a refund as your financial institution will automatically credit you with the refund. Once you become aware that the chargeback dispute was denied, you may wish to contact Adroits ********************* to confirm the status of the refund we have promised you in this response. They may be reached at *******************************************. Please note that in my experience, your bank will notify you of their decision sometimes weeks before they notify our Company, so there may be some lag before we are able to confirm the decision. If you have any other problems, our ********************* staff will be able to assist.
Adroit deeply regrets that you did not find that your limited medical plan sufficiently met your needs. I hope that this response and the remediation offered herein satisfactorily addresses your concerns.
Best regards,
******* *****
General Counsel & Chief Compliance OfficerInitial Complaint
Date:10/11/2024
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I enrolled in a multi plan PPO in January 2024, where they were supposed to be in network and pay a discount for Services. I was provided with the insurance information cards for the plan and it there is a claims number clearly stated on the back where my doctors billing department could submit claims. Apparently nothing has been done since March claims have been unpaid no explanation given cant get through to the customer service number tried multiple times, obviously a scam but they accept my $370 per month and the initial $400 for an enrollment fee to be in a nationwide PPO network. I basically I paid $370 for nothing. I didnt even get medication coverage that I was supposed to get discounts .I ended up going with good RX because they gave a better discount when I first asked about this back in February. They said oh theyre just not familiar with this, but I asure you theres no problem with it its very easy to use ! , Well apparently my doctors offices which there are several are all coming now with statements are with hundreds and thousands of dollars old for services back in March and April that Im just finding about it now !!! Had I known this I wouldve canceled immediately I need Help. I cant get through to anyone but they do collect my money every month please help me .!Business Response
Date: 10/15/2024
Dear Ms. ********************* you for making Adroit Health Group (Adroit or the Company) aware of your dissatisfaction with your Impact Health limited medical plan. As you know, a limited medical plan is not comprehensive health coverage and is only intended to provide members, and their covered dependents, with basic insurance benefits that are capped at specific amounts for specific services. Per the terms of your policy, you are to be paid a fixed indemnity benefit in the event of a covered accident or sickness. The fixed indemnity benefits include the following: (1) hospital confinement benefit--$100/day for up to thirty days per coverage year; (2) physician office visit (primary and specialist) benefit--$50/day for up to three days per coverage year; (3) emergency room benefit--$50/day for up to one day per coverage year. However, as you have been made aware, your plan also included a 12-mpnth pre-existing condition limitation whereby claims related to conditions for which you have received care in the preceding twelve (12) months would be excluded from coverage.
At the time of your enrollment for the Impact Health limited medical plan, you were presented a written Enrollment Agreement by your sales agent. This Enrollment Agreement was reviewed and executed by you on December 7, 2023, at 11:11 a.m. The purpose of the Enrollment Agreement is to memorialize what you are agreeing to purchase and to make sure that you receive full and complete disclosures of all material terms of your plan. To that end, your attention is called to the following disclosures from your Enrollment Agreement:
1. Impact Health Limited Medical plan is made available through the ***************** of Employers and offers affordable benefits designed for individuals and families who need basic, routine wellness coverage or expanded coverage to help address day-to-day health care expenses. (******* Enrollment Agreement, 12/7/2023, p. 2)
2. A Limited Benefit Medical plan is NOT A COMPREHENSIVE MAJOR MEDICAL PLAN, NOR IS IT INTENDED TO REPLACE A MAJOR MEDICAL PLAN. The plan is intended to provide members, and their covered dependents, with basic insurance coverage that is capped at specific amounts for specific services. (******* Enrollment Agreement, 12/7/2023, p. 3, emphasis added)
3. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (******* Enrollment Agreement, 12/7/2023, p. 3, emphasis original)
4. You understand that you have a free trial period of 30 days. During this trial period or free look, you can cancel this membership and receive a full refund excluding the onetime enrollment fee, as long as you have not used any benefits. (******* Enrollment Agreement, 12/7/2023, p. 4)
5. You understand that the insurance coverage included with this membership is an accident and sickness hospital indemnity plan. (******* Enrollment Agreement, 12/7/2023, p. 4)
6. You confirm that the details of the accident and sickness hospital indemnity plan have been explained to you by your agent, including the limitations and exclusions. (******* Enrollment Agreement, 12/7/2023, p. 4)
7. This policy provides limited benefits on a fixed indemnity basis. It does not constitute comprehensive health insurance coverage (often referred to as major medical coverage) and does not satisfy a persons individual obligation to secure the requirement of minimum essential coverage under the *************** Act (ACA). (******* Enrollment Agreement, 12/7/2023, p. 4)
8. You understand the plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment. (******* Enrollment Agreement, 12/7/2023, p. 4)
9. You understand that if you have a pre-existing condition, the accident and sickness hospital indemnity benefits may not be immediately available for claims associated with this condition. (******* Enrollment Agreement, 12/7/2023, p. 4)
10. You understand specifically, if you have had care rendered or prescribed to you by a physician within the 12 months leading up to your effective date, you will have a waiting period for 12 months before any claims related to your condition will be covered. (******* Enrollment Agreement, 12/7/2023, p. 4)
11. You understand that the BENEFITS INCLUDED WITH THE ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN ARE NOT DEPENDENT ON THE USE OF THE MULTIPLAN PPO NETWORK. (******* Enrollment Agreement, 12/7/2023, p. 5, emphasis added)
12. You understand that if there are any discrepancies between what the agent told you about the plan and what the actual policy states, that the policy terms will apply. (******* Enrollment Agreement, 12/7/2023, p. 5)
13. Pre-existing Condition Limitation - There is NO COVERAGE FOR A PRE-EXISTING CONDITION FOR A CONTINUOUS PERIOD OF 12 MONTHS FOLLOWING THE EFFECTIVE DATE OF A COVERED PERSONS COVERAGE under the Policy. (******* Enrollment Agreement, 12/7/2023, p. 6, emphasis added)
14. I agree that I have a full and complete understanding of the products for which I am applying. (******* Enrollment Agreement, 12/7/2023, p. 13)
15. By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. (******* Enrollment Agreement, 12/7/2023, p. 13)
As reflected in the contractual excerpts referenced above, your policy was not comprehensive health insurance, and instead provided only limited benefits in the form of fixed indemnity payments that are payable directly to you and not paid to your providers. This was clearly disclosed to you in writing at the time of sale, and you were afforded a full thirty-day period to review the account and all coverages during which you were free to cancel for any reason and receive a refund of your charges.
To clarify, the use of an in-network provider does NOT affect your eligibility for benefits under your Impact Health limited medical plan. However, utilizing an in-network provider, while not required, is advisable because it reduces the out-of-pocket costs you incur against which those fixed indemnity payments can be applied. Therefore, you would receive the same $50 benefit for a physicians office visit regardless of the physician you utilizedwhether in-network or out-of-network. For example, the use of an in-network provider might result in you being charged $75 for that visit versus $125 for an out-of-network provider, for which you would have received the same $50 payment from your plan.
Therefore, assuming that the services you received were for covered accident or covered sickness, and assuming again that those services were not for a pre-existing condition, your policy would pay you $50 per day for physician services (either primary care or specialist or a combination thereof) for a maximum of three days.
Unfortunately, our Company is not the insurance carrier nor are we the carriers third-party claims administrator. This means that Adroit has no involvement with, nor any authority over, the claims reviews, claims processing, and claims payment. Hence, we have no visibility into the basis for any claims determinations that may or may not have been made, nor do we have any ability to resolve your claims-related issues all of which reside solely with your carrier and its third-party claims administratorneither of whom are Adroit.
We acknowledge that you have contacted Adroits ************************** with several claims inquiries, at which time you were directed to the ***************** at the carrier. As you have been previously advised, all questions regarding claims status and payments should be directed to International Benefits Administrators, who is the third-party claims administrator for the Impact Health Plan. Their contact information is as follows: International Benefits Administrators, Attn: ************* Post Office Box 576, ******* ********, *****, telephone: ************. If you believe that your claims are not being properly addressed, we urge you to follow up directly with International Benefits Administrators at the number provided above.
With regards to your complaint concerning medication coverage, we note that your Impact Health limited medical plan does not provide prescription coverage, although you do enjoy certain prescription discounts through your membership as noted on your membership identification cards and plan materials. A copy of your membership identification card reflecting these discounts is enclosed with this response for your ongoing reference.
Adroit regrets that you have been unable to receive a sufficient response to date from Impact Health and its third-party administrator, International Benefits Administrators, and we apologize for the challenges you have encountered. We have attempted to relay your problems to the *** in hopes that they follow up with you directly. Further, we note that, as a courtesy, you have been refunded your most recent four (4) months of payments in the amount of $307.70 each. Receipts evidencing these four refunds are appended to this response for your reference.
Best regards,
******* *****
General Counsel & Chief Compliance OfficerInitial Complaint
Date:09/30/2024
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Last year, possibly around May 2023, I unfortunately and accidentally signed up for an insurance plan with Adroit health group. I paid my premiums monthly and on time. I was seen a patient on 1/17/24 and 01/24/24, and I have now received 2 bills from this time frame. One bill of the bills came from Quest diagnostics. I have been in contact with them regarding this bill. I told them I had two insurances at the date of service. They verified my member ID with both ********************** agencies which would be adroit health group and BCBS. I was told it would take a while to receive an answer back from the insurance company. I now have with me a bill from 9/4/24 and it states payment was denied by QS allied national global indicating patient could not be identified as a member. Every single day last week, I have attempted to called their claims department, without answer. The wait time is always something ridiculous like 2 hrs long. I give the automated system my number to call me back and they call me back telling me the office is now closed. Last week, I reached out to ***** health resources regarding another bill that this insurance has not paid for the same dates of service. I am highly frustrated. Last week, I wrote them a letter and mailed it to the claims department. My premium was $230.75 monthly from June 2023-Dec 2023. My premium changed and the new amount of $165.80 was paid for Jan and Feb 2024. I finally ended the insurance on 2/29/24.Business Response
Date: 10/03/2024
Dear Ms. *********************** you for making Adroit Health Group (Adroit) aware of the problems you are encountering with your health care services. We have no knowledge of any plan associated with QS Allied National Global or BCBS (presumably ***********Blue Shield) as neither product is sold on our platform. Our records indicate that you purchased an Impact Health limited medical plan (underwritten by ****************** Security Life Insurance Company) on April 14, 2023, and per your request, the plan was cancelled as of February 29, 2024. You also had initially had an association membership and non-insurance products that were cancelled in December of 2023, which resulted in an adjustment to your monthly charges as referenced in your complaint.
Hence, we are unable to address your complaint about QS ********************** denying your membership therein. Again, this is not an entity with which we are associated, and therefore, we are unable to provide any information concerning this matter. We can confirm that between the dates of May 01, 2023, and February 29, 2024, your Impact Health limited medical plan was in effect for covered services in accordance with the policy terms and guidelines. A copy of the plan certificate that details all of your coverages in included with this response for your reference. Of note, your plan was the Single-100 plan which provides fixed indemnity benefits for covered accidents and covered sicknesses in the following amounts:
1. Hospital Confinement Benefit - $100 Per Day of Confinement with a maximum of 30 *********************************************************************************** Care Physician and ************** Physician: $50 per day with a maximum of 3 days per coverage year combined.
3. Emergency Room Benefit $50 Per Day with a maximum benefit of 1 day per coverage year.
4. Accidental death benefit of $10,000 with reduced benefit for covered spouse and children.
As you will note, there is no indemnity benefit payable under your plan for laboratory services. However, your plan does provide for certain laboratory discounts to which your Quest diagnostics bill may be eligible, provided you complied with the plan requirements. You should consult the Impact Health plan certificate.
With regards to your complaint about having difficulties obtaining claims information, we must remind you that Adroit is not the carrier and we have no authority over nor any involvement with claims review, claims processing, and claims payment. Further, under Federal privacy law, our Company has no access to your health care claims information. Our records do reflect that you placed several calls to Adroits ************************** for the purpose of inquiring about the status of your claims, at which time we facilitated a transfer of your call to the carriers third-party claims administrator. Unfortunately, we have no control over wait times for this separate company. However, our ********************* did conduct an internal audit of wait times for Adroits **************************, and we found that wait times averaged less than six (6) minutes. As previously disclosed, you may contact the carriers claims departmentwhich again, is not affiliated with Adroitat the following telephone number: ************.
We regret the frustrations that you have experienced in getting your claims addressed. Any problems involving QS Allied National Global and BCBS should be directed to them. Any problems involving claims under the Impact Health limited medical plan should be directed to the carrier, ****************** Security Life Insurance Company, and its third-party claims administrator, International Benefits Administrators, Post Office ********************************* If you believe that your laboratory services are entitled to a discount under your Impact Health limited medical plan, you should follow up in accordance with the plan guidelines. Should you have any further problems, please feel free to contact Adroits ********************* at *********************************************.
Best regards,
******* *****
General Counsel & Chief Compliance OfficerCustomer Answer
Date: 10/10/2024
I am rejecting this response because: my biggest concern is the claims department has been unreachable for the last few weeks that I have been calling. The phone number that is listed Here is the phone number that I have been calling for the last two weeks and the phone number that adroit health member services gave me. They even stayed on the phone with me and called the number on 3 way, and still no one ever came to the phone. A 6 min wait time? Thats comical! I have called them several times with no call back. I got the phone number from the insurance card that I once had in my position. The name of this scam of a company is very much of a mind ******. Many of these names came from the front and back of the insurance card and/or the bill that I have received from my doctors office.
The only way this problem can be solved is if I can speak with someone from the claims department so we can go over these claims or the next time that the claims come across their desk that they should be approved if my insurance covered those services. I reached out to my doctors office and quest diagnostics to have them resubmit the claims. As I said, previously, I received in writing from quest diagnostics, saying that my claim was rejected from this insurance because I did not have an active membership at the time of services, which is false. Also, it did not say your insurance did not cover these services, and thats why your claim is being denied.Business Response
Date: 10/10/2024
Dear Ms. ***************** you for making Adroit Health Group (Adroit) aware of your ongoing problems with getting your claims paid by ****************** Security Life Insurance Company (AFSLIC) and its TPA, International Benefits Administrators (IBA). As previously explained, both AFSLIC and IBA are wholly separate and distinct companies from Adroit. We do not own or operate either of these companies.
Further, Adroit does not have any involvement with any portion of claims review, claims processing, and claims payment. Likewise, Adroit has no authority to review your claims, process your claims, and pay your claims. Moreover, Adroit has no information in our records concerning your services, your bills, or the payment or denial of reimbursement for those services. In fact, under Federal privacy laws, Adroit cannot have access to any of this information because it is your personal, protected health information.
For your future reference, the Impact Health Plan is underwritten by ****************** Security Life Insurance Company, whose contact information is ***************************************************, ************** or **************. The third-party claims administrator for ****** and the Impact Health Plan, which is the entity responsible for claims review and claims payment for this product, is International Benefits Administrators, Post Office ********************************, **************.
We are very sorry that AFSLIC and IBA are not being sufficiently responsive to your inquiries. However, Adroit does not staff ******* or **** telephone lines nor do we have any access to their e-mail system. Your complaints should be directed to ****** and *** and not to our Company because we are simply unable to provide you with the relief you are requesting. However, as a courtesy we have this date contacted ****** and *** on your behalf and asked that they follow up with you as quickly as possible. Apart from that, there is nothing further we can do to make a third-party company act.
Best regards,
******* *****
General Counsel & Chief Compliance OfficerCustomer Answer
Date: 10/11/2024
I am rejecting this response because: How am I supposed to know the insurance I signed up for goes by all these different names and each one has a different job. What role is your company, Adroit health group, play in all these? I have never in my life encountered so much chaos from an insurance company or maybe i should say real, reputable companies such as ********************** or united healthcare. I simply signed up for the insurance, received the card, then went to my doctor and gave them the same card. I have already submitted another BBB claim for the *********** benefits administrators which is the company I have been trying to contact for the last several weeks without success since there is nothing your company can do. Thank you for your time.Initial Complaint
Date:08/23/2024
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
I would like to formally make a complaint against Adroit Health Group, its affiliate Strata Health group, and the underwriting agency ****************** Security Life insurance *** (AFSLIC). Strata Health group and its employees failed to fully disclose pertinent information regarding plans and policies being offered to us for enrollment. Strata allowed its employees to fraudulently represent a discount plan as an affordable healthy family plan by using misleading language as a sales tactic and failing to inform us of essential information necessary in making informed consent for enrollment. My husband and I (**** & *****************************) were never informed or disclosed to that we were enrolling in/enrolled in a discount services program and NOT a traditional health insurance plan like we were led to believe by Strata Health groups and its employees resulting in a failure to provide adequate health coverage for our family. We have repeatedly been sent balance bills from multiple hospitals and offices as well as phone calls from hospital billing departments as recently as this month, August 2024, all from claims made during the covered period in 2022/23 for both my son and myself that were denied any coverage by Strata health. A recent notification sent via text message from *********************** on 8/19/24 indicating a cancelled payment plan is what sparked further investigation and discovery of the fraud and deception we have been subjected to by Adroit Health Group, its affiliate Strata Health group, and the underwriting agency ****************** Security Life insurance *** (AFSLIC). In total we paid Adroit Health Group $13,951.55 for nothing more than a discount services program and have received bills and continue to receive bills totaling $8778.82, some of which we had to pay some that are considered pending and are due. I hope that in pursing these complaints someone can help inform and support me with any and all available options to mitigate these discrepancies.Business Response
Date: 08/27/2024
Dear ******************,
Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with your Impact Health limited medical plan purchased through our Company. While our Company regrets that you did not find that the products purchased on our platform sufficiently met your family's needs, we feel compelled to address certain erroneous allegations raised in your complaint.You are in error when asserting that our Company allowed our employees to make purported misrepresentations to your husband when he purchased the account. ******************** does not engage in any direct-to-consumer sales. Rather, our company is a general agency and field marketing organization that solely makes certain insurance and non-insurance products available for sale by licensed third-party sales producers through our enrollment and billing platform. All sales on our platform are conducted by third-party agencies and their agents who are not employed by Adroit, nor does our Company have any ownership or operating interest in same. If you believe a sales producer misrepresented a product to you, your complaint should be directed to that sales producer, whose contact information is included in the product materials provided to you at the time of sale.
Moreover, in order to ensure that customers purchasing products on our platform understand what they are purchasing, Adroit requires that all sales on our platform be completed through the presentation and execution of a written Enrollment Agreement. Your husband received the Enrollment Agreement and signed the contract on August 19, 2022, at 12:51 p.m., indicating his understanding and acceptance of the terms. A copy of your husbands Enrollment Agreement is included with our response for your reference. The purpose of this Enrollment Agreement is to provide important disclosures concerning material aspects of the transaction, specifically including but not limited to product benefits, exclusions and limitations, and associated costs. At the time of enrollment, you received access to our online Member Portal that includes all plan documents, including product guides. Further, Adroit provides all customers with a thirty-day period to review the transaction and cancel without obligation for any reason in the event you find anything in the account and the products to not be to your liking. Despite this thirty-day review period, you did not elect to cancel the account and continued enjoying the benefits of your Impact Health limited medical plan until November of 2023.As will be shown in more detail below, all statements made by Adroit in the Enrollment Agreement were factually accurate and consistent with how your account was subsequently handled. Likewise, your assertion that you were never informed or disclosed to that we were enrolling in/enrolled in a discount services program and NOT a traditional health insurance plan like we were led to believe is also in error. First and foremost, your husband purchased a limited medical plan, whose modest coverages commensurate with the modest cost for same was clearly disclosed to you at the time of purchase. This limited medical plan is decidedly more than a discount plan as you have alleged, although you are correct that it is not comprehensive health insurancea fact that was also clearly and repeatedly disclosed to you at the time of purchase. Specifically, your attention is called to the following specific disclosures in your Enrollment Agreement:
1. Impact Health A Limited Benefit Medical plan is NOT A COMPREHENSIVE MAJOR MEDICAL PLAN, NOR IS IT INTENDED TO REPLACE A MAJOR MEDICAL PLAN. The plan is intended to provide members, and their covered dependents, with basic insurance coverage that is capped at specific amounts for specific services. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis added.)
2. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis original.)
3. You understand that the insurance coverage included with this membership is an ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN. (******* Enrollment Agreement, 08/19/2022, p. 4, emphasis added)
4. THIS POLICY PROVIDES LIMITED BENEFITS ON A FIXED INDEMNITY BASIS. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS MAJOR MEDICAL COVERAGE) AND DOES NOT SATISFY A PERSONS INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). (******* Enrollment Agreement, 08/19/2022, pp. 4-5, emphasis added.)
5. You understand the plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment. (******* Enrollment Agreement, 08/19/2022, p. 5)
6. You confirm that the details of the accident and sickness hospital indemnity plan have been explained to you by your agent, including the limitations and exclusions. (******* Enrollment Agreement, 08/19/2022, p. 4)
7. You understand that you have a free trial period of 30 days. During this trial period or free look, you can cancel this membership and receive a full refund excluding the onetime enrollment fee, as long as you have not used any benefits. (******* Enrollment Agreement, 08/19/2022, p. 4)
8. You understand that if after using the program, at any time you are not satisfied, you may cancel your membership, and your benefits will be terminated at the end of the billing cycle for which you were billed. You, then, will not be billed any further. (******* Enrollment Agreement, 08/19/2022, p. 4)
9. You understand that if there are any discrepancies between what the agent told you about the plan and what the actual policy states, that the policy terms will apply. (******* Enrollment Agreement, 08/19/2022, p. 5)
10. I understand the details of the membership including the membership fees. I have read and agree to the General Membership Disclosures. I have read and agree to the Insurance Disclosures). (******* Enrollment Agreement, 08/19/2022, p. 7)
11. I agree that I have a full and complete understanding of the products for which I am applying. (******* Enrollment Agreement, 08/19/2022, p. 11)
12. By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. /s/ *********************** (******* Enrollment Agreement, 08/19/2022, p. 12)
We do note, however, that in addition to the Impact Health limited medical plan, your husband did purchase several other discount products, which may well be what you are alluding to; however, these products are not insurance which was also disclosed at the time of purchase and did not carry the benefits that you were attempting to use at your various health care providers (which were included in your Impact Health limited medical plan. Nevertheless, the disclosures for these other products also specifically reference that they are not comprehensive health insurance, to wit:
13. Wellness Plans of *******, WPA, is NOT MAJOR MEDICAL OR COMPREHENSIVE MEDICAL INSURANCE COVERAGE, AND IS NOT A MINIMUM ESSENTIAL HEALTH BENEFIT PLAN UNDER FEDERAL AND/OR STATE LAW. The benefits will not satisfy the individual mandate as defined by the Patient Protection and *************** Act. ). (******* Enrollment Agreement, 08/19/2022, p. 8, emphasis added)
14. Wellness Plans of America, WPA, is NOT MAJOR MEDICAL OR COMPREHENSIVE MEDICAL INSURANCE COVERAGE, AND IS NOT A MINIMUM ESSENTIAL HEALTH BENEFIT PLAN UNDER FEDERAL AND/OR STATE LAW. The benefits will not satisfy the individual mandate as defined by the Patient Protection and *************** Act. defined by the Patient Protection and *************** Act. (******* Enrollment Agreement, 08/19/2022, pp. 8-9, emphasis added)
As clearly evidenced hereinabove, you were advised multiple timesincluding disclosures with bolded text for emphasisthat the products you were purchasing did NOT constitute traditional health insurance. You were also provided specific information concerning the limited coverages that were available under your plan, including the specific services and indemnity payment that would be paid to you by the carrier. A copy of the plan certificate that was made available to you in the electronic Member Portal is also enclosed with this response. You will note that the Impact Health limited medical plan pays a fixed indemnity benefit directly to you, and not to your health care provider. As detailed in that plan certificate and your Enrollment Agreement, the Impact Health plan did, in fact, provide substantial benefits, which were significantly more robust than mere discounts as has been alleged, including:
- Hospital Confinement Benefit - $500 per day of confinement up to a maximum of 30 days per coverage year.
- ***************** Benefit - $50 per day for ************ or ***************** Visit for a maximum of 5 days per coverage year.
The Impact Health Plan also includes fixed indemnity benefits for surgery, Diagnostic X-ray and Laboratory Testing (including interpretation), emergency room services, mental health services, and supplemental benefits related to accident, critical illness, and accidental death. Therefore, it is simply erroneous to claim that you received nothing more than discount services. If you, in fact, believe that your claims under the Impact Health plan were improperly denied, you should pursue your appeal rights through the plan as spelled out in the Plan Certificate, which is attached. Unfortunately, Adroit is not the insurance carrier nor are we a third-party claims administrator, and therefore we have no involvement with nor authority for claims review, claims processing, and claims payment.
With regards to your claim that your providers claims were denied, we should again point out that our Company does not have any involvement with claims, and therefore, it is inaccurate to assert that our Company denied your coverage. Conversely, we again reiterate the provisions of your plan stating that the benefits under the Impact Health limited medical plan are payable directly to you and not to the provider. Therefore, if your provider is indicating that it did not receive a payment as you have alleged, that non-payment would be consistent with the terms of your plan, and instead, you should follow up with the carrier to obtain the indemnity payment provided under the plan which, as indicated in your certificate is payable to you.
Furthermore, with regards to the text message you received from your hospital on August 19, 2024, indicating that you had a cancelled payment plan, we note that your account was cancelled at your request on November 17, 2023 (with an effective date of November 24, 2023). A copy of the cancellation confirmation e-mail that was sent to you at that time is appended to this response for your reference.
In sum, there is no evidence of any fraud and deception on the part of Adroit Health Group, and we respectfully dispute any such allegations. You were provided ample disclosures and consistent, accurate information by Adroit concerning the products, coverages and limitations, and costs for same. You were provided a full thirty-day period to review the transaction and cancel for any reason. If you believe claims may have been improperly denied, your best recourse is to follow up directly with the carrier and/or its third-party claims administratorneither of whom are Adroit.
We sincerely regret that you were dissatisfied with the products purchased through our Company, but we believe you have been treated fairly. Nevertheless, as a courtesy, Adroit is willing to refund your most recent payment in the amount of $852.35. This should not be construed as an admission of any fault or liability on the part of Adroit Health Group, but instead represents a transaction and compromise of a disputed claim that is being done as a courtesy for a valued customer. However, the refund would be for the October-2023 payment, and therefore if you have any pending claims for this time period, it might result in the denial of those claims. Therefore, we want to give you the option to pursue any outstanding fixed indemnity claims with the carrier. If you have no claims for this period and/or wish to forego any reimbursement for same, kindly e-mail Adroits ********************* at ****************************, referencing this BBB complaint. Based on your request and understanding the potential claims impact, we will be happy to direct a refund of the October-2023 payment.
Should you have any further questions, please feel free to contact Adroit Health Groups ********************* via e-mail at ****************************.
Best regards,
*************************
General Counsel & Chief Compliance OfficerCustomer Answer
Date: 09/04/2024
To whom it may concern,
While I do appreciate your prompt response in addressing my grievances with your companies product, Im greatly disappointed at the lack of concern in regard to the representation and sale of those products to consumers by third-parties. Id hoped that in alerting you of such misrepresentation your company would have taken the necessary action to further assess the situation before denying any fraud or responsibility. Strata/Adroit Health Group does indeed have a responsibility to its consumers to comprehensively identify, *****, and mitigate possible risk potential with regard to the representation and sale of your products by third parties as part of your due diligence. Therefore, I do believe there is a degree of responsibility that should be addressed on behalf of your company.
Although I can understand why you would include the enrollment contract as evidence of tranperency, I made it very clear when I filed my complaint that the contract was NOT signed in good faith. The product was undoubtedly misrepresented to us by the third party individuals selling your product. And as I also pointed out, our point of sale transaction was processed and collected by Adroit Health Group in June of 2022 and continued monthly until November of 2023 when we cancelled. You listed the contact signature as August of 2022, an obvious discrepancy as the payment was in fact processed in June of 2022 two months prior to the date you have listed as the contact date. Although you emphasize in your response what the contract coverage parameters are, my husband and I both do not recall those parameters ever being disclosed verbally, in plain English, in real time, over the phone during the point of sale. Further more, I do not agree that signing a contract in real time via a text message link as adequate time to review or understand the parameters of what is being signed, especially when the product have not been represented truthfully. Also, with regard to the patient portal link information being mailed to us to access the contract as evidence of disclosure, I would like to point out again that we enrolled in a short term medical plan prior with no major issue, so when presented with another policy (Impact Policy) framed as similar by the agent in June of 2022 ( using misleading language such as PPO, A great option for health families, 70/30%) we had no reason to suspect otherwise.
Misrepresentation alone IS considered grounds to invalidate the contact. While I can understand why you would include the above stated items as evidence of disclosure, Ill remind you that none of this was disclosed or understood at the point of sale over the phone. We were clearly taken advantage of and sold a policy that did not deliver what was promised. Although I may have noted minor changes in the begining, nothing to the degree that would alert me to the serious lack of coverage for our family until months after and well outside of the 30 day cancelation period. Had it not been for my shoulder injury in April of 2023 and my sons broken arm in May of ***************************************************************** monthly premiums for what we thought was major medical insurance but was in fact nothing more than limited and discount coverage at best.
I would like to yet again note that we did not start to receive balance bills until months after the ORIGINAL service dates of ****** **** and June of 2023 (specifically October of 2023 for myself and November of 2023 for my son). All of which were billed during the covered period between June of 2022 and November of 2023. Those bills were the FIRST MAJOR indication that there was a lack in coverage, hence the cancellation in November of 2023. Although concerned with the amount of money we owed in back billing, we did not understand the scope of how truly misinformed we were until August of 2024 with the notification of outstanding bills and discovery of MORE pending bills we currently face. All from the covered period of June 2022-November of 2023 for which we thought we had purchased major medical coverage, but clearly was not.
Im saddened at your ***** presumption of fairness as the lack of which has undoubtedly been made clear. I am greatly disappointed at the unwillingness of Adroit/Strata Health Groups to accept any accountability whatsoever. While I do not believe your company had any direct malicious intent towards me, I am appalled at the lack of empathy expressed in your response as your company did in fact benefit from the misrepresented sale of the Impact policy to usregardless of who sold it. I do believe that it is your companies responsibility to comprehensively assess third party risk by those representing and selling your products as part of your due diligence to ensure that they are being represented truthfully and responsibly to consumers. Therefore I feel we have grounds to ask for a full refund in the amount of $13,951.65 for the monthly premiums billed during the period of June 2022 - November of 2023 for which we were sold, and enrolled in a policy that was falsely represented and for which Adroit Health Group accepted payment for.
Furthermore, in an effort to be transparent I would like to disclose that
any error on billing/notification has been addressed with the medical and hospital billing departments respectively and all parties have been made aware of the current situation. All grievances with the agency and individuals involved in the sale have been addressed in separate complaints that have been filed with the appropriate agencies both on a states and federal level.
I sincerely hope that these grievances are taken seriously and that we can work together to find a reasonable solution.
Best,
***************************;Customer Answer
Date: 09/04/2024
I am rejecting this response because:
I have sent further information to the BBB for review.
Business Response
Date: 09/05/2024
Thank you for your thorough response. We have previously attempted to address each of your concerns at length as well as offer a partial refund to you as a courtesy, which we again renew to you now.
To reiterate our prior response, our Company does not engage in any direct-to-consumer sales and we, in fact, made no misrepresentations to you whatsoever. If you believe a sales producer misrepresented a product to you, your complaint should be directed to the third-party sales producer with whom you dealt and whose contact information is included in the product materials provided to you at the time of sale. To the contrary, our Company made every effort to provide you with accurate and complete disclosures of the product benefits, exclusions and limitations, and associated costs. Specifically, your attention is called to your Enrollment Agreement dated August 19, 2022, containing numerous disclosures concerning the products you were purchasing and specifically noting that these products were not major medical insurance. These important disclosures included, again, each of the following (without limitation):
1. Impact Health A Limited Benefit Medical plan is NOT A COMPREHENSIVE MAJOR MEDICAL PLAN, NOR IS IT INTENDED TO REPLACE A MAJOR MEDICAL PLAN. The plan is intended to provide members, and their covered dependents, with basic insurance coverage that is capped at specific amounts for specific services. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis added.)
2. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis original.)
3. You understand that the insurance coverage included with this membership is an ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN. (******* Enrollment Agreement, 08/19/2022, p. 4, emphasis added)
4. THIS POLICY PROVIDES LIMITED BENEFITS ON A FIXED INDEMNITY BASIS. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS MAJOR MEDICAL COVERAGE) AND DOES NOT SATISFY A PERSONS INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). (******* Enrollment Agreement, 08/19/2022, pp. 4-5, emphasis added.)
Further, consistent with our Company policy and the terms of your contract, you were afforded a full thirty (30) day period to review the products and cancel for any reason, at which time you could have received a refund of all monies paid. However, you and your husband chose not to avail yourself of this right.
Similarly, with regards to your claim that your providers claims were improperly denied, we respectfully remind you that our Company does not have any involvement with claims nor any authority to review, process, and pay claims. If you believe the claims were adjudicated in error, your recourse is to follow the plans appeal processes, which again must be directed to the carrier and/or their third-party claims administrator, as they are the entities that can address these issues.
Lastly, as detailed in our prior response and in the opening paragraph of this most recent communication, Adroit is willing to refund your most recent payment in the amount of $852.35 solely as a courtesy to you. This should not be construed as an admission of any fault or liability on the part of Adroit Health Group, but instead represents a transaction and compromise of a disputed claim. However, again because you have indicated that you may still have pending claims for this time period, the refund could result in denials for any claims for services during this period. Therefore, we want to give you the option to first pursue any outstanding fixed indemnity claims with the carrier. If you have no claims for this period and/or wish to forego any reimbursement for same, you may so advise Adroits ********************* at ****************************, referencing this BBB complaint. Based on your request to proceed with the refund and your acknowledgement of the potential claims impact, we will be happy to issue a refund of your October-2023 payment.
Should you have any further questions, please feel free to contact Adroit Health Groups ********************* via e-mail at ****************************.Customer Answer
Date: 09/06/2024
I am rejecting this response because: To whom it may concern,
While I do appreciate your prompt response in addressing my grievances with your companies product, Im greatly disappointed at the lack of concern in regard to the representation and sale of those products to consumers by third-parties. Id hoped that in alerting you of such misrepresentation your company would have taken the necessary action to further assess the situation before denying any fraud or responsibility. Strata/Adroit Health Group does indeed have a responsibility to its consumers to comprehensively identify, *****, and mitigate possible risk potential with regard to the representation and sale of your products by third parties as part of your due diligence. Therefore, I do believe there is a degree of responsibility that should be addressed on behalf of your company.
Although I can understand why you would include the enrollment contract as evidence of tranperency, I made it very clear when I filed my complaint that the contract was NOT signed in good faith. The product was undoubtedly misrepresented to us by the third party individuals selling your product. And as I also pointed out, our point of sale transaction was processed and collected by Adroit Health Group in June of 2022 and continued monthly until November of 2023 when we cancelled. You listed the contact signature as August of 2022, an obvious discrepancy as the payment was in fact processed in June of 2022 two months prior to the date you have listed as the contact date. Although you emphasize in your response what the contract coverage parameters are, my husband and I both do not recall those parameters ever being disclosed verbally, in plain English, in real time, over the phone during the point of sale. Further more, I do not agree that signing a contract in real time via a text message link as adequate time to review or understand the parameters of what is being signed, especially when the product have not been represented truthfully. Also, with regard to the patient portal link information being mailed to us to access the contract as evidence of disclosure, I would like to point out again that we enrolled in a short term medical plan prior with no major issue, so when presented with another policy (Impact Policy) framed as similar by the agent in June of 2022 ( using misleading language such as PPO, A great option for health families, 70/30%) we had no reason to suspect otherwise.
Misrepresentation alone IS considered grounds to invalidate the contact. While I can understand why you would include the above stated items as evidence of disclosure, Ill remind you that none of this was disclosed or understood at the point of sale over the phone. We were clearly taken advantage of and sold a policy that did not deliver what was promised. Although I may have noted minor changes in the begining, nothing to the degree that would alert me to the serious lack of coverage for our family until months after and well outside of the 30 day cancelation period. Had it not been for my shoulder injury in April of 2023 and my sons broken arm in May of ***************************************************************** monthly premiums for what we thought was major medical insurance but was in fact nothing more than limited and discount coverage at best.
I would like to yet again note that we did not start to receive balance bills until months after the ORIGINAL service dates of ****** **** and June of 2023 (specifically October of 2023 for myself and November of 2023 for my son). All of which were billed during the covered period between June of 2022 and November of 2023. Those bills were the FIRST MAJOR indication that there was a lack in coverage, hence the cancellation in November of 2023. Although concerned with the amount of money we owed in back billing, we did not understand the scope of how truly misinformed we were until August of 2024 with the notification of outstanding bills and discovery of MORE pending bills we currently face. All from the covered period of June 2022-November of 2023 for which we thought we had purchased major medical coverage, but clearly was not.
Im saddened at your ***** presumption of fairness as the lack of which has undoubtedly been made clear. I am greatly disappointed at the unwillingness of Adroit/Strata Health Groups to accept any accountability whatsoever. While I do not believe your company had any direct malicious intent towards me, I am appalled at the lack of empathy expressed in your response as your company did in fact benefit from the misrepresented sale of the Impact policy to usregardless of who sold it. I do believe that it is your companies responsibility to comprehensively assess third party risk by those representing and selling your products as part of your due diligence to ensure that they are being represented truthfully and responsibly to consumers. Therefore I feel we have grounds to ask for a full refund in the amount of $13,951.65 for the monthly premiums billed during the period of June 2022 - November of 2023 for which we were sold, and enrolled in a policy that was falsely represented and for which Adroit Health Group accepted payment for.
Furthermore, in an effort to be transparent I would like to disclose that
any error on billing/notification has been addressed with the medical and hospital billing departments respectively and all parties have been made aware of the current situation. All grievances with the agency and individuals involved in the sale have been addressed in separate complaints that have been filed with the appropriate agencies both on a states and federal level.
I sincerely hope that these grievances are taken seriously and that we can work together to find a reasonable solution.
Best,
***************************;Attachments: 22.pdf Customer Answer
Date: 09/11/2024
To whom it may concern,
This dispute with Adroit Health Group/Strata Health Group has not been settled.
Per ****************************Duration Health Insurance Coverage Act (215 ILCS190) section 15 (effective February 1, 2019) clearly states in section c that the bold faced typed disclosure statement MUST be read aloud over the phone to protect the purchaser. THIS WAS NOT DONE. We were mislead by third party sales to believe we were purchasing full healthcare, which we in fact did not. This is a clear violation of that law. Im asking for a full refund of all premiums paid for the Impact Health Plan we were sold not in good faith and were enrolled in from June 2022 - November 2023.
(215 ILCS 190/15)
(Section scheduled to be repealed on January 1, 2025)
Sec. 15. Disclosure requirements.
(a) A health insurance issuer that offers short-term, limited-duration health insurance coverage to be delivered or issued for delivery in this State shall, in addition to all other documents required, including, but not limited to, the policy, the certificate, the membership booklet, and a description of appeal and external review rights, deliver an outline of coverage to an applicant for or an enrollee in short-term, limited-duration health insurance coverage delivered or issued for delivery in this State.
(b) Any short-term, limited-duration health insurance coverage policy that is delivered or issued for delivery in the State shall display prominently in the policy, any application, sales, and marketing materials provided in connection with enrollment in such coverage, and the outline of coverage for such coverage, in at least 14-point, bold type, the following: "NOTICE: THE SHORT-***** LIMITED-DURATION INSURANCE BENEFITS UNDER THIS COVERAGE DO NOT MEET ALL FEDERAL REQUIREMENTS TO QUALIFY AS "MINIMUM ESSENTIAL COVERAGE" FOR HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT. THIS PLAN OF COVERAGE DOES NOT INCLUDE ALL ESSENTIAL HEALTH BENEFITS AS REQUIRED BY THE AFFORDABLE CARE ACT. PREEXISTING CONDITIONS ARE NOT COVERED UNDER THIS PLAN OF COVERAGE. BE SURE TO CHECK YOUR POLICY CAREFULLY TO MAKE SURE YOU UNDERSTAND WHAT THE POLICY DOES AND DOES NOT COVER. IF THIS COVERAGE EXPIRES OR YOU LOSE ELIGIBILITY FOR THIS COVERAGE, YOU MIGHT HAVE TO WAIT UNTIL THE NEXT OPEN ENROLLMENT PERIOD TO GET OTHER HEALTH INSURANCE COVERAGE. YOU MAY BE ABLE TO GET LONGER TERM INSURANCE THAT QUALIFIES AS "MINIMUM ESSENTIAL COVERAGE" FOR HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT NOW AND HELP TO PAY FOR IT AT WWW.HEALTHCARE.GOV.".
(c) Any individual selling a short-term, limited-duration health insurance coverage policy in this State in face-to-face or telephonic sales interactions must read out loud the disclosure in subsection (b) to a prospective purchaser. An entity selling a short-term, limited-duration health insurance coverage policy in ******** must display the disclosure in subsection (b) on the webpage where a prospective purchaser would purchase coverage.Initial Complaint
Date:08/19/2024
Type:Service or Repair IssuesStatus:AnsweredMore info
Complaint statuses
- Resolved:
- The complainant verified the issue was resolved to their satisfaction.
- Unresolved:
- The business responded to the dispute but failed to make a good faith effort to resolve it.
- Answered:
- The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
- Unanswered:
- The business failed to respond to the dispute.
- Unpursuable:
- BBB is unable to locate the business.
Hello,** was laid off of work and had to obtain health care coverage for my family. ThriveHealth STM was the health care coverage my past employer suggested that I use as well as the State of Arkansas.Shortly after I was laid off (~4 months) I became very ill, after verifying who I could see with ThriveHealth STM I was diagnosed with Cancer (appendiceal mucinous neoplasm). It did take several tests to figure out what the cancer was, and all of it was new testing and diagnostics. I had surgery in November 2023 to have the cancer removed and am medical rest for 12 months and waiting on disability as the cancer effected many organs and I had to have many of those organs completely removed as well having chemotherapy. Finally I am now receiving bills from *******************, ****************************** and Hot Springs Radiology with large amounts of patient balance for the medical treatment I received.ThriveHealth STM covered $3,409.28 leaving me with a total amount due of $35,449.17 I have tried to call ThriveHealth several times an most of the time I wait on hold for 2+ hours and then they disconnect me, or I leave my call back number and they never call me back. I was able to finally get ahold of someone today and they said that they could only look at 2 of the date of services when I have 16 I need to talk with them about. I paid all my premiums and now the health insurance company is refusing to help pay for my medical bills.Business Response
Date: 08/20/2024
Dear ******************,
Thank you for making Adroit Health Group (Adroit) aware of your unsatisfactory experience with the payment of your health care bills. Unfortunately, Adroit is not in a position to assist you. We have no record of any account corresponding to the (i) name, (ii) address, (iii) telephone number, or (iv) e-mail address that has been provided in your complaint. We have specifically searched for an account using your last name (*******) as well that of the surname in the e-mail address you submitted (*********). Based on your complaint, we have also searched for records of both a ******* and a ********* in both ******* and ******** and have been unable to locate any matching account. Likewise, there is no record in our system of anyone having either your telephone number or e-mail address.
Further, at no time has Adroit ever sold a ThriveHealth STM product on our platform. It is respectfully suggested that you may have identified the wrong party in your complaint.
However, if you believe the information reported in your initial complaint is in error (such as, perhaps you purchased a different plan that was, in fact, sold through Adroit) or you are not the designated account holder (but perhaps instead a beneficiary of someone who does have an Adroit account), please feel free to contact Adroits ********************* at ****************************, and we will be happy to investigate further and respond to your complaint. Likewise, if you believe our research is in error, kindly e-mail ****************************, and provide the Adroit membership identification number for the account and we will follow up as soon as possible.
Lastly, please note that if you have had claims denied by any insurance carrier, you generally have certain appeal rights; but these rights are often time-limited, so you are encouraged to please follow up as soon as possible.
Best regards,
*************************
General Counsel & Chief Compliance Officer
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