ComplaintsforAssured Benefits Administrators, Inc

• Initial Complaint

  07/08/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Doctor filed a claim to ABA on 1/27/22 while I was insured with them. I received an EOB on 11/9/23 denying the claim saying it wasn't filed in a timely manner. I got a printout of the online claim filed from the Dr. where it was filed on 1/27/22. I sent all of this information to ABA, and now I can't get a response from them. This is the second time they have done this. This is the worst insurance company ever with the absolute worst customer service. They use the excuse "not filed in a timely manner" to deny paying covered charges. Now I'm stuck with another bill that should have been covered by insurance.

  Business response

  07/11/2024

  We apologize for the slow process. Can you please provide your group number as well? It will help us get to the bottom of this in a timely fashion.
  

  Thanks!

• Initial Complaint

  04/26/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This company is the third party administrator for health insurance for my husband's company. We have had many claims that have not been properly processed. They have been resubmitted multiple times with minimal response. The HR company we work with had to notify the higher up executives to receive an answer. While an answer was given, the hospital has not received the additional payment from ABA Admin and my bill has not been lowered. An in-network provider was not covered and I owe $1100 for multiple visits. They reportedly told the HR company that they are having money issues and have since dodged any inquiries. I am also completely locked out of their online portal and cannot see EOBs or check the status of any of these inquiries.

  Business response

  04/29/2024

  Providing the highest level of customer service is our number one priority and we sincerely apologize for failing to meet your expectations.
  Please feel comfortable reaching out to me directly to find a solution to your issue at ********************** Please include your full name, phone number, and group number in your email. Thank you!
  

• Initial Complaint

  03/18/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  Assured Benefits Administrators are still processing a claim for a dr's **** on July 6 2023.I contacted ABA on Jan 8 2024 & spoke with a **** ****** He confirmed that the payment was approved and I had to wait for the funds to be released. He said that he would email the accounting **** to inquire as to why I would have to keep waiting. On Feb 12 I contacted ABA again as no payment has been received. I again spoke with rep ***** who repeated that I had to wait for the funds to be released and that I could not speak with anyone in the accounting **** as they were not taking any calls.I have been in contact with my doctor's office/ Trinity Health to communicate what ABA shared. They have made notes in my file etc but in April this bill will go to collections. *** had sent out an EOB for this claim, showing that they will pay none of the $223, which is why I contacted ABA in Jan. **** I spoke with a billing rep at **************, she explained that they received the same EOB as I did and if they receive an updated EOB with the correct/adjusted amount that that would change the amount I am due to pay.I attempted to contact ***'s office of the president however an internet search has returned multiple unrelated businesses using the same address and suite# as ABA.My Insured# with ABA is ************. According to ABA, I have 2 claims in process for this $ amount on 7/6/23 and they are ****************************************** According to ***, the first claim# is the claim that has payment approved but funds need to be released.As of March 18th, ABA has not processed this claim, despite processing several claims I have sent in after 7/6/23. Since my doctor has received an EOB from ABA stating that I owe the full amount and conversations with an ABA rep is not enough to change the $ amount that is owed, my credit is now at risk with this bill going to collections.

  Business response

  03/21/2024

  Providing the highest level of customer service is our number one priority and we sincerely apologize for failing to meet your expectations.
  Please feel comfortable reaching out to me directly to find a solution to your issue at ********************** Please include your full name, phone number, and group number in your email. Thank you!

  Customer response

  03/21/2024

  I am rejecting this response because:   this is a generic, almost automated response, with no name, phone #, any contact info, any direction on if this is the correct area to contact or contact info for the appropriate ***** any acknowledgement of my complaints or any further resolution. Perhaps this needs to be escalated to someone with ability to resolve these issues, but this response completely ignores the issues, and repeating them yet again to a generic email will just be wasted time.

  Business response

  03/21/2024

  I apologize if it felt generic. I will need the information requested in order to assist. Can you provide your legal name, group and group number?

  Thank you!
  

  Customer response

  03/21/2024

  I am rejecting this response because:  the response requests information already provided, in detail, in the original email. 

  Customer response

  03/25/2024

  3/25/24 I have spoken again with ABA rep ***** who provided these amounts as approved and pending payment by ABA: $165.97 & $170.12

  This is after I was contacted by my dr's ****** who stated that they had received multiple denials of these claims as follows:

  Jan 31 per Audil B

  Feb 6 per **** A

  Feb21 per Mangal P

  Since ABA is 3rd party, and my claims show Cigna I contacted ***** in case they were the party responsible for these denials. I spoke with ****** who confirmed that my ins plan was 3rd party, and so she, and *****, are not able to see claims or plan details, and therefore unable to speak to claim status i.e. deny claims.

  It seems that ABA is denying, at least verbally or via email, these claims to my dr's ****** despite another rep stating that they will be paid. ABA is also unable to provide an EOB for these claims as they are in process, to show the amounts that they would cover (listed above).

  Business response

  04/09/2024

  Hi,

  We are having a hard time locating your records based on the name you provided. Please email me with your full name and group number so we can help. *********************

  Thanks,

  ******

  Customer response

  04/11/2024

  Attached is a screenshot from the ABAAdmin.com portal

  As evident in the screenshot, these are the 2 claims in process previously referred to in the complaint history. However, according to ABA Admin's automated phone claim status, these claims have been paid on Jan 1, 1900. Not sure if this is an issue?

  If whoever @ ABA Admin is responding to these complaints cannot find anything for me based on my name, ABA Insured #, dates of service , claim amounts, claim #s and now a picture from their own portal, perhaps this needs to be escalated to someone who can?

  Business response

  04/19/2024

  Thank you for including the screenshot. I will get this over to the manager and we will respond from ********************** Please be sure to check your spam folder for our response.

  Always,

  ABA

  Customer response

  04/19/2024

  I am rejecting this response because:   their response indicates they need time to investigate & follow up with resolution

  Customer response

  05/24/2024

  *** followed up with me and I received calls on April 24th or 25th. I spoke with customer service rep ********************************** who assured me that *** had contacted my healthcare provider Trinity ****** and Trinity understood payment was on the way and that this bill would not be sent to collections. ****** recognized that an *** for this claim, showing what *** would pay, would be helpful and sent me a copy which is attached.
  Trinity, most likely automatically, had also sent me an email notifying me that the full amount was now due on May 12th. I sent that to ****** as well, who said that it shouldn't have occurred, and my guess is that it was an automated notification.
  On May 7th, nearly 2 weeks after the phonecall, ***'s portal still showed the claim as in-process. Since the May 12th deadline from Trinity was approaching, I was hoping this payment would be made by then and so I followed up with ****** via email asking for help. I have not received a response.
  On May 15th, I received another notification from Trinity that not stated the full amount was now overdue. I attached that email and sent it over to ******, again asking for help. I have not received a response.
  
  At this point, *** needs to contact Trinity so that they can confirm receipt of the payment and adjust the bill.
  
  Below is the text from the emails referenced above:
  
  From: *********************** <************************>
  Sent: May 15, 2024 3:03 PM
  To: ********************************** <*****************************>
  Subject: Re: ***
   
  Hey ******, didn't receive a reply & hoping you can still assist with the below as now Trinity ****** has emailed the attached stating the balance is past due.
  
  Please let me know,
  Thanks,
  
  ***********************
  ************************
  
  From: *********************** <************************>
  Sent: May 7, 2024 10:19 AM
  To: ********************************** <*****************************>
  Subject: Re: ***
   
  Hey ******, hope you're doing well
  I wanted to follow up as this claim still shows as in-process.
  
  
  
  
  As I previously mentioned, my healthcare provider Trinity ****** sent a bill requesting payment of the full amount be made by May 12, and I was hoping this claim would be processed so that the correct/adjusted amount would be reflected for me to pay in time.
  
  Would you be able to follow up with the **** responsible for making this payment to Trinity and possibly let me know if there's an update?
  
  If you'd prefer to give me a call, my # is ************ and I'm available today and pretty much the rest of the week
  
  Thanks very much,
  
  
  
  ***********************
  ************************
  ****************************************
  
  From: *********************** <************************>
  Sent: April 25, 2024 3:14 PM
  To: ********************************** <*****************************>
  Subject: Re: ***
   
  Hey ******, yes you are correct - when I've spoken to them in the past, they let me know that the bills (at least at this point) are auto-generated so this was definitely created & mailed out before we spoke. I just wanted to mention that although I received a bill, the due date is 3 weeks out so hopefully my healthcare provider receives payment & updates the amount before then. Of course, I will reach out if I need more assistance, but wanted to thank you again for following up with this
  
  Thanks so much!!
  
  ***********************
  ************************
  ****************************************
  From: ********************************** <*****************************>
  Sent: April 25, 2024 3:03 PM
  To: *********************** <************************>
  Subject: Re: ***
   
  Hello ******, 
  
  That should not have happened! My guess is that the letter was mailed before I spoke to them over the phone. 
  I just checked with IT and they have not updated the system to reflect that yet, but I can assure you it  has been processed and you should see it on your end soon.
  
   I hope you have a wonderful day.
  
  Thank you
  
  **********************************
  
  Customer Service Representative
  
  
  
  Email *****************************
  
  Address: ****************************************** www.abadmin.com
  
  From: *********************** <************************>
  Sent: Thursday, April 25, 2024 12:25 PM
  To: ********************************** <*****************************>
  Subject: Re: ***
   
  Hey ******, thank you so much for following up with this!
  Looking at the *** member portal, it looks like the claim still shows as in-process, so hopefully it will be updated. I did get a bill from my healthcare provider this week but the due date is May 12; hopefully the adjustment will go through before then
  
  Thanks again,
  Hope you have a lovely rest of the day,
  
  ***********************
  ************************
  ****************************************
  From: ********************************** <*****************************>
  Sent: April 25, 2024 2:20 PM
  To: ************************ <************************>
  Subject: ***
   
  Hello ******, 
  
  This is ******, we spoke over the phone 2 days ago. Please see the *** attached to this email. 
  Please refer to the Employee's Responsibility section on the top right, under "claim summary"
  
  Thank you 
  
  **********************************
  
  Customer Service Representative
  
  
  
  Email *****************************
  
  Address: ****************************************** www.abadmin.com

  Business response

  06/03/2024

  Good afternoon,
  I have reached out to Trinity ****** regarding an account balance and claim status pending. Spoke with ******* a representative from trinity health, she advises there is no outstanding balance and is waiting for payment on claim status of DOS 07/06/2023 Billed Amount: $223.00.  I have attempted to call you (the member); there was no answer so I left a message.Please reach out to me directly at ********************* with any further questions.
  

  Customer response

  06/03/2024

  I have reviewed the business response and accept this resolution. 

  As of Weds 5/29 Trinity updated the balance on this bill accordingly so it appears that ABA's payment has come through.

• Initial Complaint

  03/01/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  This is the adminstrator my former health insurance policy. We have spent countless hours attempting to get them to reimburse us for items such as my hospital stay. The majority of the issues have been resolved, however we submitted a claim for my breast pump on July 11, 2023, which we were told would be reimbursed. After countless phone calls and getting bounced around, my husband confirmed they supposedly cut a check for the pump. We never received said check. We followed up around October, 2023 and they said they had to run a "check trace", which would take ***** business days. We followed up AGAIN today after being on hold quite a while and being bounced around to several different people with no resolution at this time. Supposedly the person who handles this is out. We have spent countless hours by now trying to resolve this issue. This company is incredibly inefficient and at this point I consider it stealing both our time and money.

  Business response

  03/05/2024

  Providing the highest level of customer service is our number one priority and we sincerely apologize for failing to meet your expectations.
  Please feel comfortable reaching out to me directly to find a solution to your issue at ********************** Please include your full name, phone number, and group number in your email. Thank you!

• Initial Complaint

  02/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My employer, DMOS, offered employees health insurance through ABA (Assured Benefit Administrators) for calendar year 2023. I have several claims with date of service June 7, 2023 through October 10, 2023 that have not been processed/paid. Ive called at least monthly, if not biweekly on a specific claim for DOS 6/7/23 for $37,330.10. Every time I checked on status, I was told to wait 2 more weeks. 6 months (allowing 2 months for normal processing time) has passed and this claim is still outstanding. I check the portal for status of my claims weekly and have watched this claim sit in the processing que for months. On January 10, ****, this claim moved to completed. I could see an EOB showing allowed amount, contract discount, patient responsibility, paid date of January 9, ****, check # and paid amount; only to find out on January 31, ****, this claim was not paid and has since been deleted from the portal. Still to this day, can not get anyone at this company to tell me what is going on with my claims and why they are not being paid. Im being threatened with collections on one of the claims due to insurance not paying it and another claim that hasnt been paid is for medical supplies. That company is withholding my supplies until their claim is paid, which will become a life or death situation for me.My resolution is simple. PAY THESE CLAIMS PROMPTLY!

  Business response

  02/05/2024

  Providing the highest level of customer service is our number one priority and we sincerely apologize for failing to meet your expectations.
  I have escalated your message to my ********. You will hear from them within 72 hours.

  Thanks!

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