ComplaintsforStrata Health Group

• Initial Complaint

  07/02/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I have called to cancel this a few times and they refuse to cancel my membership. They say that I need to give them information on the new insurance that I have, but wont cancel this membership. I have already made one payment and dont want to have another.

  Business response

  07/08/2024

  **************:
  
  Thank you for making Adroit Health Group aware of the problems you have encountered with cancelling your account.  Our normal protocol whenever members want to change any part of their plans is to connect them with their agent-of-record.  In most cases, the agents will want to make sure that someone cancelling has alternate coverages available and/or a qualifying life event because the cancellation will fall outside an open enrollment window.  Absent other coverage or a qualifying life event, it might result in the member going without any health care coverage for the remainder of this year. If this line of inquiry caused you to be ill-at-ease, I sincerely apologize. We do note that it appears you made several calls inquiring about cancellation, and your request should have been handled more promptly. For this I apologize.  We are reviewing every staff member from both Adroits ************************** to your third-party agents customer service office to determine with whom we need to address this issue.  We will be following up to ensure that this sort of problem does not recur in the future.  Thank you for bringing this to our attention.
  
  Adroits ********************* has already followed up on your request and confirmed that your account has been cancelled, and a full refund of your charges in the amount of $245.95 has been processed.  I am enclosing copies of the cancellation confirmation notice and refund receipt for your records.  Please be advised that, depending on your particular financial institution, it can take up to five (5) business days before a refund posts to your bank account.  If you have not seen the refund by this time next week, please feel free to contact me directly at *******************************************, and Ill be happy to follow up for you.  Again, please accept my sincerest apologies for the problems you have experienced.
  
  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer

• Initial Complaint

  06/21/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I was sold the insurance plan on 2/1/2024. Was unable to use (per contract) until 3/1/34. When used, their webiste and contract were inaccurate with what I could do. All claims were denied, even after customer service rep harassed me into staying with the company and harassing my doctor's ****** into accepting the coverage. The plan covered nothing and was falsely represented.

  Business response

  06/24/2024

  ************,
  
  Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with the Impact Health limited medical insurance plan and the *** Goodlife non-insurance discount plan purchased through our Company.  Please be advised that Adroit does engage in any direct-to-consumer sales.  Rather, our Company provides third party sales contractors with access to certain insurance and non-insurance plans through our electronic enrollment and billing portal. Your account was sold by a third-party sales contractor who is not an employee of Adroit Health Group.  Your sales agency operates its own separate customer service department, and this appears to be the group with whom you have dealt in this matter.  
  
  Our records reflect that you contacted Adroit on only one occasion, which was on April 01, 2024, at 2:26 p.m.  At that time, you indicated that you wished to speak with someone about cancellation. We immediately put your account on hold and removed the next-billing-date so that you would not be automatically charged while the cancellation process ran its course with your designated agent-of-record.  At that time, you were transferred directly to your agent-of-record for follow-up.  We are not aware of any purported harassment by your agent and/or the agencys customer service department.  However, because of your complaint, Adroit has made their management team aware of your experience and asked that they conduct their own internal review of what *** have transpired.  
  
  We do note, however, that despite your claims that you harassed into staying with the company, your cancellation was processed by the agent-of-record on April 01, 2024, less than thirty (30) minutes after your initial call was received by Adroit and transferred over to them.  A copy of your April cancellation e-mail confirmation is enclosed with this response for reference.  Furthermore, the one and only time that your account reflects that you contacted us regarding problems with your plans was on that April 01, 2024, call, and in fact, you were not charged after that date for anything further.  You were charged on April 01, 2024, in accordance with your contractually-authorized monthly payment, which we should emphasize occurred prior to receiving any complaint from you.  Presumably, it was this regular monthly charge that prompted your cancellation request.  Because your contract requires that you make your cancellation request at least five (5) days prior to the draft date of your payment, we were unable to stop the April 01, 2024, payment draft at 3:34 a.m., based on a cancellation request that occurred nearly twelve (12) hours after the fact. However, we are pleased to report that you incurred no further charges after your cancellation request.  It is assumed that what you characterize as harassment on the part of your agent-of-record *** well have been his/her attempt to ensure that you fully understood the import and consequences of what you were doing, as your cancellation placed you without any insurance coverage outside of an open enrollment window and potentially without special circumstances that would warrant an exception to procure alternative coverages.  If these efforts were received negatively, we apologize on her behalf, although again, we note that the agent-of-record is not an Adroit employee nor is his/her agency owned by, operated by, or affiliated with Adroit.
  
  With regards to your claim that the plan(s) were falsely represented, we are unfortunately unable to provide a thorough response because you have not indicated precisely in what manner they were misrepresented.  Nevertheless, we will provide some limited commentary concerning the nature of any alleged misrepresentations in general followed by addressing what appears to be your dissatisfaction with payment denials on a series of charges you incurred in April-2024.  
  
  As we detailed hereinabove, Adroit functions solely as a general agency and field marketing organization. Again, we do not engage in direct-to-consumer sales;  rather, all sales on our enrollment platform are conducted by licensed third-party sales producers who contract with our company to utilize our enrollment platform.  We are not privy to any discussions that are held between these sales contractors and prospective customers, although our agreements require that the sales producers provide accurate information at all times concerning product coverages, exclusions and limitations, and associated costs.  Additionally, in order to ensure that there are no miscommunications, Adroit requires that all customers received, review, and execute an Enrollment Agreement at the time of sale, outlining all material terms of the transaction.  You received, reviewed, and executed your Enrollment Agreement on February 05, 2024, at 3:29 p.m.  Based on the content of this document, which is enclosed with this response for your benefit as well as that of the BBB, it is clear that you were purchasing a plan that provided modest, fixed benefits and not a comprehensive health insurance plan.  Your attention is called to the following disclosures made to you at the time of sale in your ********************************************************************************************************************************* 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. .  (Horn Enrollment Agreement, 02/05/2024, p. 3, emphasis added)
  
  
  2.         THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE.  (Horn Enrollment Agreement, 02/05/2024, p. 3, emphasis original)
  
  3.         You understand that the insurance coverage included with this membership is an ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN. (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  4.          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. (Horn Enrollment Agreement, 02/05/2024, p. 4)
  
  5.          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). (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  6.         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.  (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  7.          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. (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  8.          You understand that the benefits included with the Accident and ***************** Indemnity Plan are NOT DEPENDENT ON THE USE OF THE MULTIPLAN PPO NETWORK.  (Horn Enrollment Agreement, 02/05/2024, p. 5, emphasis added)
  
  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.   (Horn Enrollment Agreement, 02/05/2024, p. 5)
  
  10.        I agree that I have a full and complete understanding of the products for which I am applying. (Horn Enrollment Agreement, 02/05/2024, p. 12)
  
  11.       By electronically acknowledging this authorization, I acknowledge that I have read and agree
  to the terms and conditions set forth in this agreement. (Horn Enrollment Agreement, 02/05/2024, p. 13)
  
  We must reiterate that we have no information concerning what misrepresentations were allegedly made by the third-party sales producer.  However, we also reiterate that this sales producer was not an employee of our Company.  We also went above and beyond to provide ample written disclosures to you at the time of sale concerning all material aspects of your account, and we afforded you a full thirty-(30) day period to review your purchase, cancel for any reason during such time, and receive a full refund.  For whatever reason, you chose not to avail yourself of these cancellation and refund rights and, in fact, only sought a refund after being charged for the plan in future months.  The fact that you did subsequently call in to cancel on April 01, 2024, underscores that you had the knowledge and capability to cancel, but did not exercise those rights until you incurred more charges and after any time period for avoiding the previous payment had passed.  Likewise, the agent-of-record (who again, is not an Adroit employee) acted promptly to finalize and cancel your account at the same time as you called in, which is inconsistent with your claim of harassment.
  
  With regard to your generalized allegation of misrepresentation, we will assume that the unpaid charges you incurred are the bases for alleged misrepresentations.  Please be advised that Adroit is not the health insurance carrier (which is ****************** Services Life Insurance Company, which is NOT an affiliate of Adroit Health Group, LLC) nor are we a third-party claims administrator for that carrier. You have provided documentation of three dates of service: (1) April 09, 2024a preventative ***** visit performed by Advocate Medical Group;  (2) April 15, 2024laboratory services at PBV Advocate Lab; and  (3) April 27, 2024an emergency room visit at ********************************   We emphasize that Adroit is not involved in claims review, processing, and payment, and we have no information concerning what was determined and why it was determined in that manner.  However, based on our review of your policy documents, inclusive of your Enrollment Agreement and Plan Certificate, we note the following:
  
  With regards to April 09, 2024, preventative health visit, your Impact health Limited Medical Plan provides coverages only for services rendered for Accidents and Sicknesses.  The plan requires that all services be associated with a covered accident or covered illness.  A preventative health visit is, by definition, neither a result of an accident or a sickness, and therefore, would not have been covered under your plan. Nothing was misrepresented; rather, the services you received were clearly not covered under the plan, which was articulated to you at the time you purchased the plan and in all plan documents provided continuously thereafter.
  
  With regards to the April 15, 2024, laboratory services,  you provided a print-out of network lab providers from the MultiPlan Network. First and foremost, we note that laboratory services were not listed in the array of covered benefits under your Impact Health Limited Medical Plan, which features the MultiPlan Network.  Per the terms of your Enrollment Agreement, you have laboratory discounts available under your *** Goodlife non-insurance plan, which does require that you utilize a different network of providers.  It *** be that the laboratory that you utilized is not associated with the DirectLabs Network, or alternatively, that lab is a DirectLabs Network participant, but the charges were incorrectly submitted and not processed under the right plan.  A copy of the ***B GoodLife member guide that explains your lab benefits is also enclosed with this response.  
  
  (As an aside, we call your attention to the provision in the Enrollment Agreement detailing that use of the Multiplan Network is not required for coverage of charges under the Impact Health Limited Medical Plan.  As a fixed indemnity plan, the slate of fixed benefits is payable directly to you if you receive covered services for reasons of accident or sickness.  The MultiPlan network allows for those services to be discounted for you, which then allows your fixed indemnity payment to stretch farther and cover more of your out-o-pocket costs; but ultimately, the decision to use an out-of-network provider at a higher cost resulting in more out-of-pocket costs to you, or an in-network provider at a lower cost resulting in less out-of-pocket costs to you, is entirely your decision and neither choice affects the amount of the fixed indemnity payment you are to receive.)
  
  With regards to your April 27, 2024, emergency room visit, it appears that this likely qualifies for a payment under your Impact Health Plan.  The plan appears to reimburse you for one emergency room visit per covered person per year in the amount of $50.00, which would be required to be for services related to a covered accident or covered sickness.  We are not aware of the underlying purpose for the emergency room visit, but presume by the nature of the service itself, you would have a covered accident or covered illness, but again, this is speculative.  Additionally, we note that the plan has a pre-existing condition limitation, which might impact your receipt of benefits under the plan, so please be aware.  Ultimately, if you believe that this particular service should have resulted in your receipt of the $50 emergency room fixed indemnity payment, you should pursue this further with the carrier (AFSLIC).  Adroit is not in the position to make this determination and have no involvement in same.  It appears that the hospital attempted to bill this charge and was denied, which in our view appears to be the correct decision under your plan because the fixed indemnity payment is payable to the customer and not to their provider.  So, it appears you should pay the hospitals bill and then submit the claim to AFSLIC, who will issue you the $50 fixed indemnity payment.  Assuming the hospital is a participant in the MultiPlan network, you should receive a discount on the services from the hospital, although again, use of a MultiPlan network provider is not required in order to avail yourself of the $50 fixed indemnity payment.  Conversely, if you personally submitted the reimbursement request to AFSLIC and they denied the payment of the Emergency Room fixed indemnity payment, you should understand the basis for that denial.  Please be aware that you are entitled to certain appeal rights, which we would encourage you to pursue in a timely manner as there are time limitations on submitting any appeal.  Unfortunately, Adroit has no authority in this regard.
  
  In sum, we believe that at the time of sale, you were provided ample written disclosures in the Enrollment Agreement that were accurate and consistent with the terms of your plan.  You were also afforded a full thirty-day period to review and consider your account during which time you had the right to cancel and receive a full refund. Lastly, we believe the charges about which you contend evidence some misrepresentations are consistent with and fully explained under your policy.  Moreover, any purported misrepresentation, if in fact made, was not made by our Company, nor does our Company have any involvement with the claims determinations to which you object. Lastly, your account was immediately cancelled upon request, and you incurred no charges thereafter.
  
  Based on the above and foregoing, it is our belief that you have been treated fairly in this matter and in full compliance with applicable law and the terms of our agreement.  Adroit sincerely regrets that you did not find that the Impact Health Limited Medical Plan and the *** GoodLife non-insurance discount program did not adequately meet your expectations.  We hope you have found other plans and products that will better suit your familys health care needs.  
  
  Sincerely,
  
  *************************
  General Counsel & Chief Compliance Officer.  
  

  Customer response

  06/28/2024

  I am rejecting this response because:   

  The condescending response does not accurately address the entirety of the claim. 

  First, if you listen to the alleged recorded call at the time of the sale of the scam, the broker was clearly told that I was looking for PRIMARY insurance coverage as I had lost my coverage through my employer. This was stated multiple times in the call. The broker ensured me that this was indeed a primary insurance policy with PPO benefits and was able to replace my coverage lost by my employer (BC/BS PPO). At the time, I asked if the Advocate Aurora or ********************* systems and doctors would be included in the coverage and I was told yes. The only stipulations that I was given for doctor's ********************* was that although paid, I could not use the coverage for 30 days unless it was for an emergency. This stipulation was followed. There was zero mention of ALL coverage being for illness/emergency. However, it turns out that even though this was apparently the case, the illness requiring a hospital visit (within the network of approved hospitals (according to YOUR network search as documented in my original complaint) was denied. Once again, I am not clear on what service you were actually providing to me. 

  In response to your claim that your agent was not abrasive and harassing- you can again listen to the phone call in which he stated that he "got me what I wanted by my doctor's ****** accepting my insurance" (see the denied claim as proof of that lie) and "if more people don't use their services they will never be able to help people because big box insurance companies like ********** will win out". It was inappropriate and a lie. Please feel free to reach out to me if you are still confused. 
  

  Business response

  07/03/2024

  Thank you for your thoughtful reply to Adroit Health Groups response.  We are very sorry that you are dissatisfied with our initial response. To reiterate what was previously relayed, the sales representative from whom you purchased your plans is not an employee of our Company.  This representative is a third-party independent contractor who maintains their own, separate customer service department.  We do not have access to any recordings of any calls between you and your sales agent.  While we take you on your word that you were indeed seeking primary health insurance, there is no indication that you were affirmatively misled by the sales contractor or that there may have been some misunderstanding of what was being transacted between you and the contractor.  This is precisely why Adroit requires that you be presented, review, and complete the Enrollment Agreement that provides ample, precise disclosures of what you are purchasing and all material terms and conditions.  As previously detailed in our earlier response, the Enrollment Agreement contained nearly a dozen specific disclosures that are in ***** contrast to your contention that you were misled.  In particular, your attention is called once again to the following disclosures in the Enrollment Agreement you provided which clearly call out that the benefits were solely for purposes of accidents and sickness, to wit:
  
  -  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. .  (Horn Enrollment Agreement, 02/05/2024, p. 3, emphasis added)
  
  -  THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE.  (Horn Enrollment Agreement, 02/05/2024, p. 3, emphasis original)
  
  - You understand that the insurance coverage included with this membership is an ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN. (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  -  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. (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  - 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)   (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  - 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.  (Horn Enrollment Agreement, 02/05/2024, p. 4, emphasis added)
  
  - 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.  (Horn Enrollment Agreement, 02/05/2024, p. 5, emphasis added)
  
  After having been presented this information, our Company also afforded you a full thirty-day period to review the various plans and benefits during which time you were free to cancel for any reason and receive a full refund.  You failed to exercise this right.
  
  With regards to your dispute about claims denial, we reiterate that we are not the insurance carrier and have no involvement with or authority for claims review, claims processing, and claims payment.  If you believe your claims were denied contrary to the terms of the policy, including determinations about network applicability, your best recourse is to appeal with the carrier.    
  
  Lastly, with regards to the poor treatment you may have received when contacting your sales agents customer service, we again emphasize that the agency operates their own, separate customer service department and this was the group with whom you spoke and about whom you are complaining.  Because of this, we do not have access to any call recordings to verify your contentions.  We agree that if this phone call was of the nature you describe, it is unacceptable.  We have addressed these concerns directly with the sales agency and asked that they monitor and make adjustments to their customer service processes.

  Adroit regrets that you are dissatisfied with your products and your sales and customer service experience. It is hoped that you did find alternate benefits through other means.
  

  
  

• Initial Complaint

  05/16/2024

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  I was informed over the phone of a health care plan that they would forward to me.Once payment was received and I was issued a member number, I checked the plan and it did not have the coverage that was discussed over the phone.I was told the plan would include ER and ambulance services and it has no coverage for these.In addition to this I was informed what the charge should reflect on my account and the actual charge was under a different name, which I did not appreciate as the scare led me to cancel my card under suspicion of fraud. This is very inconvenient. Uploaded "Charge" shows the name of the charge to my account and "Approved Charge" shows what the expected was.

  Customer response

  05/16/2024

  I have received a phone call from one of their representatives and he stated they are working to resolve this, likely tomorrow as business hours are over for today.
  
  I will send another update if the issue is resolved fully.

  Business response

  05/16/2024

  **************:
  
  Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with your *** Health Plan.  Please be advised that Adroit is a solely a general agency and field marketing organization, and as such, we do not engage in any direct-to-consumer sales.  Rather, we make certain insurance and non-insurance benefits available for sale to the public by third party sales contractors through our enrollment and billing platform.  These contractors are not employees of Adroit, but their agreements require that they provide truthful information to prospective customers concerning benefits, exclusions and limitations, and associated costs.  To the extent you believe this was not your experience, we sincerely apologize.
  
  With respect to your claim that the third-party sales contractor led you to believe that ambulance services and emergency room visits were covered under your plan, we believe that your plan does provide limited benefits for hospital confinement.  However, it does not cover emergency room services.  We hope that this was merely a miscommunication or misunderstanding concerning the plan.  We should also point out that, in order to avoid these sorts of misunderstandings, we require that all customers receive a written enrollment agreement outlining all material terms of the products being purchased.  Of note, your enrollment agreement specifies, in pertinent part:
  
  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. All covered In-******* preventive services will be 100% covered by the Plan. Out of ******* services will not be covered unless otherwise specified, and the Plan Member will owe 100% of the cost of these services. (***** Enrollment Agreement, 5/14/2024, p. 2)
  
  2.  None of the Preventive Health Services are covered if they are provided at a hospital. (***** Enrollment Agreement, 5/14/2024, p. 2)
  
  3.  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 Schedule of Benefits, which describes the benefits covered by the Plan and how these benefits are covered, including information on copays, deductibles, and limitations. (***** Enrollment Agreement, 5/14/2024, pp. 2-3)
  
  4.  The *** plan includes a supplemental benefit for hospitalization confinement payable at $1,000 a day for up to 10 days. (***** Enrollment Agreement, 5/14/2024, p. 3)
  
  Unfortunately, it seems that there may well have been some miscommunication with regards to what may have been included as part of this plans supplemental benefit for hospitalization confinement. With regards to your complaint about the name listed on your credit card statement, it is likely that the credit card company was utilizing one of our companys other trade names.  Thank you for bringing this to our attention. Unfortunately, we do not have significant control over the formatting of their bills and statements.  We apologize for any confusion or consternation that this may have caused.
  
  Nevertheless, our company policy is to permit customers a period of thirty (30) days following their purchase to review the products and if dissatisfied, to cancel and receive a full refund.  Because you are within that thirty-day free-look window, you are certainly entitled to cancel and receive a refund.  This afternoon, at your direction, I have requested that Adroits ****************** to process a cancellation of your account and refund $439.00 to your credit card.  As we discussed, depending on your financial institution, it can take up to five (5) business days before the refund is reflected on your bank statement.  If you have not seen the refund by this time next week, please contact my office directly at ******************************** and Ill be happy to follow up for you.
  
  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer
  

  Customer response

  05/23/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  05/13/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I signed up with them for medical insurance and RX discount. Ive tried to cancel it for a month because they did not fulfill their requirements of providing me with the medication needed and their medical card was just a discount card was not medical insurance. I have tried to cancel. They told me to by sending an email, no response. I have called several times they say its been taken care of. They forward me and then I get hung up on.

  Business response

  06/03/2024

  **************,
  
  Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with your NCE ************ Medical Plan.  Please be advised that Adroit does not engage in any direct-to-consumer sales.  Rather, we are a general agency and independent marketing agency that makes certain insurance and non-insurance products available for sale on our enrollment platform by licensed third-party sales contractors. Your sale was conducted by an independent agency that is neither owned nor operated by Adroit, nor is affiliated with our company.  However, our agreements with these third-party sales producers require that they provide accurate information to prospective customers concerning product benefits, exclusions and limitations, and associated costs. To the extent you believe this was not your experience, we sincerely apologize.
  
  To ensure that our members fully understand what they are purchasing, Adroit requires that all sales on our platform be consummated through the provision, review, and acceptance of a written Enrollment Agreement.  Your Enrollment Agreement was received and executed by you on March 07, 2024, at 1:20 p.m.  The purpose of the Enrollment Agreement is to bring to your attention all of the material terms and conditions of your account.  Further, you are entitled to thirty (30) days to review the account and if dissatisfied for any reason, you may cancel and receive a full refund.  Your attention is called to pages 2-3 of your Enrollment Agreement that precisely discounts the benefits available under your NCE ************ Medical Plan.  You will note that the following benefits are detailed:  Plan **************************************************************************************************** Visit Benefit, Emergency Room Benefit.  Of note, there is no mention of any prescription medication coverage.  In fact, your plan specifies clearly, 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.  However, page 3 of your Enrollment Agreement also specifically notes that your plan does include only non-insurance discounts related solely to prescription discount benefits.
  Nevertheless, we are very concerned about what you have stated regarding having challenges in getting your account cancelled.  We have researched the communication records on your account and note that your first and only call to our *************************** seeking to cancel the account was on May 13, 2024, at 8:28 a.m., at which time you were immediately transferred to your sales agent (who again, is not an employee of Adroit) to complete the cancellation.  The notes also reflect that within 20 minutes the account was placed on a billing hold and that you were advised that you would receive confirmation of the accounts cancellation within 1-3 business days.  The account also reflects notations that the sales agent attempted to call you back on two occasions (specifically, on May 14, 2024, at 12:26 p.m., and again on May 15, 2024, at 3:40 p.m.) where voicemail messages were left for you.  Further, a cancellation confirmation e-mail was sent to you on May 16, 2024, at 11:44 a.m., which our records indicate you have never opened.  Another copy of the cancellation e-mail is enclosed with this response for your records.
  
  With regards to your request for a refund, you were entitled to receive a refund if you cancelled timely, i.e., in the first thirty (30) days of the account. Because your cancellation request fell outside this window, it would ordinarily not qualify for a refund.   However, as a courtesy to you, we have elected to refund your last payment dated April 18, 2024, which preceded the first date that you even inquired about prescription benefits (on April 22, 2024).  A copy of the receipt evidencing this refund, which has been separately e-mailed to you, is appended to this response. This refund should not be construed or deemed to constitute any concession or admission of fault or liability on the part of Adroit Health Group, LLC, or its affiliates, and rather solely constitutes a transaction and compromise of a disputed claim.  Depending on your particular financial institution, it may take up to five (5) business days for the refund to be reflected on your bank statement.  If you have not received this refund by this time next week, please feel free to contact my office at *******************************************.  
  
  Thank you for being a valued customer of ********************.
  
  Sincerely,
  
  *************************
  General Counsel & Chief Compliance Officer
  

• Initial Complaint

  05/09/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  May 1st I paid $198.00 for insurance to what I thought was ********** insurance per agent. However, when I called ********** they said I didnt have a plan to start May 2nd. Then days later I received email for Android Health. I checked my bank statement and the online payment I thought was ********** was Adroit Health a limited health service. I tried calling Adroit Health over weekend and they were closed. Then I went to pharmacy to see if I could get my asthma medication advair in which according to agent before I purchase health plan told me that it was covered. However, ******* Pharmacy where I live stated no it will be $463+. Since I couldnt call Adroit because they were close I emailed them to cancel plan because it was not what agent discussed over the phone at time of purchase and I cant get my medication for severe asthma. I believe I was lied to in fraudulent sell of what I thought was medical insurance from ********** for this agency to make a sell. Agent was not truthful I specifically asked will this policy cover my asthma medication. The agent told me yes. Now Im without medication and searching for medical plan and paid for one that doesnt work. I called during the week to cancel and be refunded. The agent kept me on phone almost a hour delaying cancellation. And at canceling stated I must keep policy until June 1st and I will not be refunded. I just want my money back and policy canceled immediately this month May 2024. So I can get a policy to get needed medication. I could have an asthma attack during this time and not be covered to get medical attention because the plan I thought I purchased is not what I was told. I do not want this company to do this to another person with illness that they want get help because this company lies to get a sell. And lack professional ethics to be truthful to customers. This is very serious. ********************************************************** - *************************************** CFXHealth********** - ********** ******************************* $198.96

  Business response

  05/31/2024

  
  Dear **************,
  
  Thank you for making Adroit Health Group, LLC, (Adroit) aware of your dissatisfaction with your recent purchase of the Impact Health limited medical plan on our platform.  We are committed to doing everything possible to resolve this matter to your satisfaction.  Please be advised that Adroit does not engage in any direct-to-consumer sales.  Rather, we are solely a general agency and independent marketing organization that makes certain insurance and non-insurance products available for sale to the public by third-party sales contractors who utilize our enrollment and billing platform.  The individual and agency responsible for the sale of your particular account is the individual identified as Your Agent in the Portal Registration E-mail you received on May 01, 2024.  A copy of that Portal Registration E-mail is enclosed with this response for your reference.  This sales agent is not an employee of Adroit nor is his agency owned by, operated by, or affiliated with Adroit.  Our agreements with these third-party contractors that permit them to access our platforms does require, however, that they provide accurate information to prospective customers concerning product offerings, exclusions and limitations, and associated costs.  To the extent that you believe this was not your experience, we sincerely apologize.
  
  However, to avoid miscommunications and to ensure that our customers know exactly what they are purchasing, Adroit requires that all sales on our platform be consummated through the execution of a written Enrollment Agreement.  You received and signed your Enrollment Agreement on May 01, 2024, at 9:46 a.m.  This Enrollment Agreement that you received contains many important disclosures concerning the products that you were purchasing.   Your attention is called to the following express disclosures:
  
  1.  The Impact Health Limited Medical Plan includes access to the Multiplane PPO Network. 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. (Minor Enrollment Agreement,05/01/2024, p. 3)
  
  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. (Minor Enrollment Agreement,05/01/2024, p. 3, emphasis original)
  
  3.  Limitations and Exclusions for Impact Health Non-Insurance Services and Discounts   Prescription Discount Benefits. (Minor Enrollment Agreement,05/01/2024, p. 4)
  
  4.  You understand that the insurance coverage included with this membership is an accident and sickness hospital indemnity plan. 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. (Minor Enrollment Agreement,05/01/2024, p. 4)
  
  5.  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). (Minor Enrollment Agreement,05/01/2024, p. (Minor Enrollment Agreement,05/01/2024, p. 4)
  
  6.  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. (Minor Enrollment Agreement,05/01/2024, p. 4)
  
  7.  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. Minor Enrollment Agreement,05/01/2024, p. 5, emphasis added)
  
  8.  I agree that I have a full and complete understanding of the products for which I am applying. (Minor Enrollment Agreement,05/01/2024, p. 10)
  
  9.  By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. (Minor EnrollmentAgreement,05/01/2024, p. 10)
  
  Additionally, your Enrollment Agreement is replete with references to Impact Health.  By contrast, there is no reference whatsoever to ********** Blue Shield. Likewise, we respectfully disagree with your assertion that you were unaware of Adroit Health Group until days later when you received an e-mail.  There are a dozen references to Adroit Health Group in the Enrollment Agreement that you signed.  Further, you received your Portal Registration E-mail exactly one minute after you reviewed and signed your Enrollment Agreement.  As you will see in this Portal Registration E-mail, which our records indicate you opened and read on May 01, 2024, at 12:15 p.m., Adroits logo is featured prominently at the top of the document, and the e-mail includes a specific section that is captioned, Understanding who we are. Likewise, our records indicate that you received both a Payment Receipt and a Summary of the Impact Health Plan exactly one minute after you reviewed and signed your Enrollment Agreement.  In totality, it is simply not accurate to say that you had no idea what you were purchasing until many days later when you checked your bank statement.  In sum, you were provided numerous, detailed disclosures both prior to your purchase, at the time of your purchase, and immediately after your purchase that detailed exactly what you were and were not purchasing, as well as who your agent was and what our Companys role was.  We regret that these efforts to properly inform you were not sufficient.
  
  Moreover, your attention is called to the listing of benefits under your Impact Health Plan (see page 3 of your Enrollment Agreement), which details 20 specific benefits including under your plan.  At no point in that listing is prescription drug coverage.  By contrast, the only reference to prescriptions is the prescription discount plan that is offered through the association.  However, there is no representation that you were purchasing comprehensive health insurance, which would include prescription coverages.  To the contrary, the disclosures you received made it very clear that you were, in fact, purchasing a limited medical plan.

  
  Unfortunately, as we detailed hereinabove, the third-party sales contractor with whom you dealt is not an Adroit employee and we were not privy to the discussions that you may have had with him.  Again, this is the reason that we go to such lengths to disclose all material aspects of the products you are purchasing at the time of sale.
  
  However, our Company policy is to permit all customers thirty days to review their purchases, and if dissatisfied for any reason, to receive a full refund of all charges.  It appears you did attempt to cancel the account with the third-party sales contractor on May 07 and again on May 14, 2024.  As you will see in the attached cancellation notice, your plan was cancelled on May 07, 2024.  The sales agency should have issued you the refund you requested at that time, and it is unclear why they did not do so.  Nevertheless, this date I have directed our ****************** to process an immediate refund of all of your charges in the total amount of $198.96.  Depending on your particular financial institution, it may take up to five (5) business days before this refund is reflected on your bank statement.  If you have not seen the refund in your account by this time next week, please contact my office at *******************************************, and Ill be happy to follow up on your behalf.
  
  Please accept our apologies for the problems you have encountered.
  
  Sincerely,
  *************************
  General Counsel & Chief Compliance Officer
  
  

  
  

• Initial Complaint

  05/07/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I am a 25 year old male who is turning 26 years old soon. I am about to be removed from my parents insurance, so I made an account with GetCovered NJ. I was contacted by ******************* on 5/6/2024. I thought he was with GetCoveredNJ. During our conversation, he told me I would not be covered by NJFamilyCare/Medicaid since my parents make over $100,00. I bought insurance from him. Later, I called GetCoveredNJ and they told me my parent's income does not matter, and I was eligible to be covered by ********* I called back the insurance company and told them to cancel my policy. The insurance company has a guarantee to refund everything except the $50 enrollment fee if the insurance is cancelled before 30 days. When I asked them if they had such a policy on the phone when I was talking to them and attempting to get them to cancel my policy, they said they did. I asked them to cancel the insurance, but they did not do so. They told me I should worry about being sick, and that I had spent a lot of time on the phone with them and they had worked hard, and that they would not refund my money. Later I learned from the cards that what they sold me isn't even insurance, even though they referred to it as insurance on the phone calls I had with them. I have attached the cards, the policy the emailed me, and the agents license to this form.

  Business response

  05/09/2024

  **************,
  
  Thank you for making Adroit Health Group (Adroit) aware of the problems you encountered with the sale of your *** Health Plan and your attempts to subsequently cancel your account.  
  
  Please be advised that Adroit is a general agency and field marketing organization, and we do not engage in any direct-to-consumer sales.  Rather, our Company makes certain insurance and non-insurance products available for all sale by third party sales producers on our enrollment platform.  All sales on our platform are conducted by independent contractors who are neither owned, operated, nor otherwise affiliated with our Company.  Our contracts require that these sales producers provide accurate information to prospective customers concerning plan offerings, exclusions and limitations, and associated costs.  To the extent this was not your experience, we sincerely apologize.  Based on your complaint, we have commenced an internal investigation of what the third-party sales producer may have represented to you concerning your eligibility for ********* and in the event we discover evidence that he made false statements to you, we will take immediate disciplinary actions.
  
  However, we respectfully disagree with your assertion that you were unaware that you were purchasing a plan that was not comprehensive health insurance.  In order to avoid miscommunications and misunderstandings of the sort you have alleged, Adroit requires that all sales on our platform be consummated through delivery and execution of a formal Enrollment Agreement at the time of sale.  You received your Enrollment Agreement on May 06, 2024.  With regards to your allegation that you were misled by the third-party sales producer that you were buying insurance, you were advised prior to sale that you while you were purchasing minimum essential coverage, you were not, in fact purchasing comprehensive insurance coverage.  Your attention is called to the following disclosures from your enrollment agreement:
  
  1.  THE *** PLAN IS NOT A MAJOR MEDICAL OR COMPREHENSIVE COVERAGE. ***** Enrollment Agreement, 05/06/2024, p. 3)
  
  2.  The *** plan covers the preventive health services required by the **** 2713 (a) without any cost-sharing requirements. All covered In-******* preventive services will be 100% covered by the Plan. Out of ******* services will not be covered unless otherwise specified, and the Plan Member will owe 100% of the cost of these services. (***** Enrollment Agreement, 05/06/2024, p. 3)
  
  3.  This Plan does not cover benefits unless listed in the Schedule of Benefits, so please review that list carefully. 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 Schedule of Benefits, which describes the benefits covered by the Plan and how these benefits are covered, including information on copays, deductibles, and limitations.  (***** Enrollment Agreement, 05/06/2024, pp. 3-4)
  
  4.  YOU UNDERSTAND THAT THE *** BENEFIT PLANS ARE NOT MAJOR MEDICAL INSURANCE AND SHOULD NOT BE VIEWED AS A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. (***** Enrollment Agreement, 05/06/2024, p. 6)
  
  5.  THE *** PLANS DO NOT COMPLY WITH THE AFFORDABLE CARE ACT (ACA), OTHERWISE KNOWN AS "OBAMACARE." (***** Enrollment Agreement, 05/06/2024, p. 6)
  
  6.  The *** Plans have a limited schedule of benefits and will only pay for those tems specifically listed in the schedule of benefits. (***** Enrollment Agreement, 05/06/2024, p. 6)
  
  7.  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, 05/06/2024, p. 6)
  
  Lastly, with regards to your claim that your request to cancel and your demand for a refund were not honored, we must again respectfully disagree.  Please be aware that your discussions both at the time of sale and the time of cancellation were undertaken with representatives of the sales agency and not Adroit Health Group.  Further, per your complaint, this request was made on the day following the original saleMay 07, 2026.  Our records indicate that both the account was, in fact, cancelled and a full refund was, in fact, processed that same date.  A copy of the cancellation e-mail, the refund receipt, and the refund notification e-mail are enclosed herewith for your reference.  We note that you opened and read the cancellation e-mail on May 07, 2024, at 12:54 p.m.which was prior to the submission of your complaint to the Better Business Bureau, although you failed to open and read the notification of refund.  We presume this is merely an oversight on your part.  Please be advised that, depending on your particular financial institution, it can take up to five (5) business days before a refund is reflected on your bank statement.  In the event you have not seen the funds hit your account by next week, please feel free to contact my office at *******************************************, and I will be happy to follow up for you.
  
  Adroit regrets that you did not find the *** Health plan to meet your needs and that you were dissatisfied with the manner in which the sale and cancellation were handled.  However, we note that the account was promptly cancelled and your charges immediately refunded despite your assertions to the contrary. 
  
  Sincerely,
  
  *************************
  General Counsel & Chief Compliance Officer
  

  Customer response

  05/09/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  05/01/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  On april twenty fifth I was contacted by an insurance company, They agreed to provide me with a Coverage That would pay for anything my basic insurance would not cover. They sent me 2 cards and no paperwork whatsoever. When I finally did go to the Doctor and took these cards they said the cards are invalid. The dentist called the number on the cards and the people told them that I am not a recipient. The representative lied to me about the coverage, I have called their number a dozen times and they have hung up on me over and over. So I called my bank and I told them that their charge was fraudulent and I had to change my account so they couldn't take any more money out. When their payment was due on the first, they did call me back.Their message was.This is your insurance agency.And when I called them to cancel and ask for a refund I had all kinds of problems. The representative was irate and I Said I wanted a refund and I wanted it canceled, He said no and I hung up.

  Business response

  05/03/2024

  **********:
  
  Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with your NCE ************ Medical Plan purchased through our Company.  We regret that you did not find the plan to satisfactorily meet your medical needs.  With regards to your specific claims:
  
  As detailed in the Enrollment Agreement that you were presented, reviewed, and signed on DATE, the particular plan you purchased was not comprehensive insurance coverage.  In particular, your pages 3-4 of your Enrollment Agreement expressly states:  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.  Rather, the plan you purchased is a limited medical plan that provides fixed indemnity benefits to you in the event you incur charges for a covered accident or illness.  Those dollars are paid directly to you, and not to the medical provider rendering those services.  Therefore, if your particular practitioner indicated that their services were not covered, this denial would have been solely with respect to the practitioners eligibility for reimbursement, as opposed to you. However, assuming that the services were in connection with a covered accident or illness, you would have been entitled to submit the charges to the insurer and be reimbursed directly in the fixed indemnity amounts provided in your policy.
  
  Further, as detailed in the Enrollment Agreement and related plan documents available to you as of the date of sale through our electronic member portal, your policy did not include any dental benefits; rather, you were entitled to discounts on dental services through the use of network providers.  These limited benefits were clearly spelled out in your account documents.
  
  Additionally, as further specified on page 5 of your Enrollment Agreement, dental services are not covered.  Specifically, the plan states, Except as specifically provided for in this Policy or any attached Riders, we will not pay benefits for Sickness or injuries that are caused by: Dental ****************** care or treatment except for such care or treatment due to accidental injury to sound natural teeth within 12 months of the accident and except for dental care or treatment necessary due to congenital disease or anomaly.
  
  With regard to the allegations of misrepresentation by the sales representative with whom you initially dealt concerning the coverages you were purchasing, please be advised that all sales on Adroits platform are conducted by third-party independent contractors. Adroit makes certain insurance and non-insurance product offerings available for sale to the public by third-party contractors through our enrollment platform.  None of these sales representatives are employed by our company.  However, to ensure that our members understand what they are purchasing, we require that customers receive and review an Enrollment Agreement containing robust disclosures concerning coverages, exclusions and limitations, and associated costs.  Among the ample disclosures of which you were made aware at the time of sale were multiple disclosures that you were NOT purchasing comprehensive insurance coverage.  
  
  Further, per the terms of your policy, you had thirty (30) days to review your products, and if dissatisfied for any reason, you were entitled to cancel and receive a full refund.  You did not exercise that right within the thirty-day window. I have reviewed the recording of your cancellation call with the sales agencys customer service representative (again, who was not an Adroit employee), and despite your contentions that he was irate, he did not raise his voice and attempted to address your complaints.  While the customer service representative did process the cancellation of your account at that time, you were denied a refund at that time because you were outside the thirty-day refund window.  
  
  With respect to your complaint about not receiving member identification cards, you are reminded that as of the date of your original sale, you had access to Adroits electronic member portal that provides digital identification cards for you use.  A copy of the member portal notification e-mail that you opened and read on March 25, 2024, at 6:18 p.m. is enclosed herewith.  Your attention is called to the following statement on that read e-mail:  If any of your product(s) enrolled include ID cards, digital ID cards are available in the member portal from the 'view and print' button next to the product name.
  
  Lastly, with regards to your complaints about not being able to speak with customer service, we have records of multiple communications between you and either Adroit **************** and/or the sales agencys customer service department, including multiple attempts on our part to return your calls and/or voicemail messages.  Following your complaint, our ********************* also tested our **************** line and found that a representative answers incoming calls within a reasonable time.
  
  Nevertheless, in light of your apparent misunderstanding of the terms of your plan, and the efforts you have undertaken to address them, we have approved a refund of all charges that you have incurred.  A refund in the total amount of $341.95 was processed to your credit card on May 03, 2024 (the same date as your BBB complaint).  A copy of the receipt evidencing this refund is enclosed with this response for your reference.  Depending on your financial institution, it may take up to five (5) business days for this refund to appear on your bank statement.  In the event you have not seen this refund reflected on your bank statement in the next week, please feel free to contact my office at *******************************************, and I will be happy to follow up on your behalf.  
  
  Best regards,
  *************************
  General Counsel & Chief Compliance Officer
  

• Initial Complaint

  04/30/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  This was suppose to be health, dental and vision insurance for the whole family that could be used anywhere. This is what was told to us. My son went to the doctor today and they gave him a prescription when giving them the information from a snapshot on my phone they advised me to contact you because it was showing up as a discount card which only saved us like two dollars. We paid ****** the first month and ****** each month after and a payment is supposed to come out May 1st but I'm trying to get it canceled or stop payment at my bank. This ************** spoke to led me to believe that it would pay 80% and some 70% that it was a insurance that we could choose any doctor anywhere. I have called 4 times in trying to get the insurance cards they keep saying go online and get the temporary cards that they were on the way or they would resend them but this has been going on over a month now. I just don't want anyone else to fall victim to this if it's truly not what they are saying it is. It sounds like what they are saying isn't exactly what it really is. I could have taken that ****** and paid my son's office visit and the medication and still had about 200. In the bank. They are making it sound great when it definitely ISN'T.

  Business response

  05/01/2024

  Mr. and *******************,
  
  Thank you for making Adroit Health Group (Adroit) aware of the problems you experienced with the sale of your NCE ************ Medical Plan. Please be advised that Adroit does not engage in direct-to-consumer sales.  Rather, we are a general agency that makes certain insurance and non-insurance products available for sale by third-party independent contractors through our enrollment platform. 
  
  As detailed in the Enrollment Agreement that you were provided at the time of sale, NCE ************ Medical Plan, this plan is not comprehensive insurance.  Rather, it is a fixed indemnity plan that provides a set payment directly to you when you receive hospital services or physician services for a covered accident or sickness.  While the plan does offer a preferred provider network, usage of the network is not required in order to avail oneself of the plans benefits, although the network does serve to reduce your out-of-pocket costs against which the plans fixed indemnity payment would reimburse you directly.  Further, while there are certain limited benefits available for dental and vision services, as expressly noted in the Enrollment Agreement that you were provided, these are solely in the form of discounts and are not full dental and vision coverage.  Unfortunately, it appears that the sales contractor did not adequately explain the plan provisions to you, and for this, we sincerely apologize.
  
  With regards to your complaint that you were not provided any member identification cards, typically the fulfillment of hard-copies of cards occurs within 5-10 days of your active date of coverage. From your account notes, digital identification cards were available as of the moment of sale through our electronic member portal.  A copy of the member portal notification e-mail that was sent to you is enclosed herewith for reference, and we note that our system shows you opened and read this information on March 11, 2024, at 2:46 p.m.  We are also enclosing a copy of the member identification card that was available to you as of March 11, 2024, via the electronic member portal.  We apologize that hard copies of this card were not immediately available.
  
  Nevertheless, consistent with our policy of affording members an opportunity to review and cancel their purchases and cancel during the first 30 days and then issuing a refund where requested, we have confirmed your cancellation this date.  Further, due to the miscommunication issues with the third-party sales contractor, we have also issued you a full refund of all charges ($358.95).  A copy of the receipt evidencing this refund is enclosed with our response for your reference.  This refund will process to your credit card of record, and depending on your particular financial institution, it may take up to five (5) business days before it is reflected on your statement.  In the event you have not seen the refund in your bank account by this time next week, please contact my office directly at *******************************************, and Ill be happy to follow up for you.
  
  Please let me know if there is anything further I can do to assist you.
  
  Kindest regards,
  *************************
  General Counsel & Chief Compliance Officer
  

  Customer response

  05/03/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  04/01/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I paid $389.95 for health insurance to Adroit Health Group on February 20,2024.I spoke with ****** who told me that this insurance had no deductible and that office visits would be $25 and specialist would be $50. Prescriptions would be no more than $30. ****** asked me where I went to the doctor?I told her that Iwent to the ******** clinic and ****** comfirmed I was covered. She asked about my prescriptions and said those were covered also . The cost was $265.95 monthly with the first payment being $389.95,$150.00 being for the no deductible. I was told I had to wait until March 1st to use the insurance. I went to my clinic,presented the insurance card they had sent me. I was told that the insurance wasn't in the system. When I went to pick up my prescriptions I was told that my insurance card didn't have insurance coverage for prescriptions.When I called the phone number for Adroit Health Group, ******* was the operator, I asked to speak with ******,she informed me that ****** wasn't taking calls and put me on hold for the next available representative. After 6 minutes ******* came back on the line to reassure me that they were real busy and then put me back on hold.This happened every 6minutes for a half hour. When my call was finally asked there was a bunch of laughing etc. going on. I spoke with ******,I explained to her how my insurance wasn't working for me, that I wanted to cancel my policy and I also wanted a refund since I didn't receive the services I was promised. She tried to resolve the issue by suggesting that I basically find a different doctor, that maybe she didn't except the insurance. I reminded her that ****** said she checked out my clinic and prescriptions and she told me I was covered. I wouldn't have purchased the policy if I wasn't covered! I want a refund.

  Customer response

  04/03/2024

  I received a phone call from ***************** today regarding my complaint. She wanted to verify that I wanted to cancel my policy. I told her I did want to cancel and was told I would be given my refund. When I asked when I could expect to see my refund in my bank account she said they normally process it by the end of the day .I decided to check to see if I had any deposits in my account.There wasn't any deposits but I was shocked to see that on April 2nd an automatic withdrawal in the amount of $264.95 to the Strata health group. I was shocked because I never gave consent for automatic withdrawal ! So the total amount owed my account is $654.90. $389.95 from February 20th and $264.95 for April 2. I will keep you updated.        *****************

  Business response

  04/04/2024

  Dear **********,
  
  Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with the sale of your  BWA ********* limited medical plan and the challenges you experienced in trying to cancel the account.  At the outset, please be advised that Adroit is a general agency only and does not engage in direct-to-consumer sales.  Rather, all sales on the Adroit platform are conducted by third party independent contractors who are not owned or operated by Adroit.  Your agent-of-record (******) is not our employee.  However, our contract with your agent-of-record requires that she provide accurate information to all customers concerning product coverages, exclusions and limitations, and associated costs.  To the extent that this was not your experience, we sincerely apologize.
  
  Our records do not reflect that you ever contacted Adroit Health Group to cancel.  However, a note from your agent-of-record was found in your account record indicates that you called in to the sales agencys customer service department on March 20, 2024, but nothing further was indicated.   While all terms and conditions applicable to your purchase were fully disclosed in the Enrollment Agreement that you were provided and reviewed at the time of sale, there was clearly some misunderstanding between you and the sales agent.  However, Adroits customers are afforded a thirty-day free look period during which they are free to review the account and cancel for any reason during which time a full refund can be received.  It does appear that you attempted to cancel during this period in your call with the sales agent, which should have been timely followed up on by the sales agent.  
  
  However, following receipt of your complaint, I directed our ****************** to process a cancellation of your account and issue a full refund of all charges that you paid.  Copies of the receipts evidencing these refunds are enclosed with this response.  Depending on your financial institution, it may take up to five (5) business days before the refund is reflected on your bank statement.  In the event you have not seen this refund in the next week, please contact my office directly and I will be happy to follow up for you.  Please accept my apologies for the trouble that you encountered.
  
  Best regards,
  *************************
  General Counsel & Chief Compliance Officer
  

  Customer response

  04/04/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  03/15/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I contacted this company by phone today (3/15/24), having found them online, to purchase health insurance for my son Tayshaun Leader. The agent quoted me an amount of $395 then charged my debit card $410.50. I called them back and got another agent who told me the amount quoted was too much for my healthy 30 year old son. She claimed to have cancelled and refunded the $410.50 and quoted me an amount of $325 instead. By now I got the impression that this was a scam company and I told her I would get my son some other coverage elsewhere. She hung up the phone. Meanwhile the charge of $410.50 was never cancelled nor refunded to me. In fact the charge has gone through on my card. I am seeking my refund.

  Business response

  03/25/2024

  **********,
  
  Thank you for making Adroit Health Group (Adroit) aware of the problems you experienced in trying to set up a TVP Health minimum essential coverage plan through your agent-of-record.  Please be advised that Adroit does not engage in any direct-to-consumer sales.  Rather, our Company is a general agency that makes certain insurance and non-insurance products available for sale on our enrollment platform by licensed third-party contractors.  However, these contractors are not employees of our organization, and many sell for a number of agencies including Adroit.  
  
  We have reviewed the communication notes on your account and there is no record of any calls from our Company to you.  For this reason, it is believed that all of the communications you had were with your agent of record.  
  
  Nevertheless, it is believed that the discrepancy you saw between the original quote $395 and the initial charge of $410.50 (which was actually $410.95) is related to a one-time enrollment fee, which was referenced in your enrollment agreement.  Your attention is called to pages 1, 4, and 18 of the Enrollment Agreement where the one-time enrollment fee is referenced. 
  
  Your account communication record does not reference any subsequent communications concerning other lower cost options that *** have been discussed with any colleague of your agent-of-record and there is nothing notated in the file about cancelling the plan prior to our receipt of your Better Business Bureau complaint, nor do our records reflect any request for a refund at any time prior to this complaint.
  
  However, based on your dissatisfaction with the sales process and your subsequent request for cancellation and refund, we have gone ahead and processed the cancellation, which was processed on March 25, 2025.  We are enclosing with our response a copy of the cancellation notice that has been separately e-mailed to you earlier this date. Additionally, because you were in the first thirty (30) days of the plan, you are *********** a refund of your charges.  However, per the terms of your contract, the enrollment fee is non-refundable (see page 4), so we initially processed only a refund of $395.95.  

  Nevertheless, in light of the frustrations you have experienced in trying to cancel the account, which we believe are outside Adroits control, we have separately issued you a refund of the $15.00 enrollment fee.  As a result, you have now been refunded in full ($410.95).  Copies of the two receipts evidencing these refunds are enclosed with this response for your reference.  Depending on your financial institution, it *** take up to five (5) business days before the refunds are reflected in your bank account.  In the meantime, should you or your son have any additional problems, please feel free to contact my office directly at *******************************************.  
  
  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer

  
  

*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. ↩