ComplaintsforMolina Healthcare of Washington Inc

• Initial Complaint

  05/06/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Molina discretely canceled my insurance without notice, and after telling me that I would be covered until the end of May.They ended it without telling me on 04/30/24, leaving me unable to get my medications. When I tried to speak with someone about the matter, I was told I had to wait 2-4 days for a supervisor to call back.I have a daily medication that is needed, so that amount of time to speak with someone is inexcusable. I told them that my medication was required for me to live, but that didn't change one thing. They ended up hanging up on me.

  Business response

  05/15/2024

  Customers Statement of the Problem:
  Molina discretely canceled my insurance without notice, and after telling me that I would be covered until the end of **** They ended it without telling me on 04/30/24, leaving me unable to get my medications. When I tried to speak with someone about the matter, I was told I had to wait 2-4 days for a supervisor to call back. I have a daily medication that is needed, so that amount of time to speak with someone is inexcusable. I told them that my medication was required for me to live, but that didn't change one thing. They ended up hanging up on me.

  I called ***** to ask him some questions along with explain to him the process for renewing coverage.
  

  I explained to ***** that Molina is a state ******** MCO ************* Organization)meaning that Molina doesnt determine eligibility for members. Because we are managed by the state or The *** they are the ones who determine coverage and update members eligibility. Starting at the beginning of this year the US determined that we are no longer in the ***** pandemic, therefor due to the pandemic being lifted ******** eligible recipients have to call to renew their coverage.During the pandemic this was waived, and ******** eligible members were automatically having their coverage renewed without having to do anything. This is no longer the case and people have to make the call to renew if they want to continue with their ******** coverage. I did a lot of research and calling different departments to figure out why your coverage termed early however, I couldn't find an answer as to why it termed early.
  
  Molina has a department called HealthPlan Renewals who helps with the renewal process. I called them to see if they knew why it termed early and they informed me that they arent able to share information like that with me, but they do know why it termed. They advised me to call ***** and transfer to them so they can explain and further assist him in renewing his coverage.

  ***** informed me that he had already called Molina's Healthplan ******************** His coverage was set to term at the end of May, he got a letter in the mail from Molina saying his coverage was going to term and to call Molina's HealthPlan ****************** to renew his coverage. ***** was being proactive and called Molina at the end of April, when he got the letter. When he called Molina's renewal department, they informed him that he made too much and that he didn't qualify for coverage for **** This is why the coverage termed a month earlier than expected for ***** is because ***** actively called to renew his coverage and didn't qualify. ***** is now upset that he was doing his due diligence and trying to be proactive with renewing his coverage and it led to him not qualifying for coverage for *** when originally his coverage wasn't going to term until the end of **** Molina didn't discreetly term his coverage without him knowing as ***** called Molina's ****************** and was advised he didn't qualify for coverage for the month of May, which has led to him not fill his medications in ****

  Customer response

  05/31/2024

  I'm at a loss as to how my complaint has been swept under the rug.  Can someone please explain that to me?

• Initial Complaint

  04/24/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Molina's ******** Advantage program has called me nearly every business day since the start of April 2024 (it is now April 24th) to ask if I wanted to switch to their program. I have said no. Repeatedly. They will not stop calling. I told them to remove me from their list and their response was to offer once again for me to switch. The representative I talked to spent the entire call of me telling them to stop calling me to try to convince me to switch into their program despite repeatedly saying no I don't want this.Included is dated screenshots going back several days of my call record from them

  Business response

  05/06/2024

  Regarding: DO NOT CALL LIST REQUEST

  This letter is in response to your grievance Molina Healthcare received on 04/24/2024.
  Your grievance is regarding your request to no longer receive calls from Molina
  Marketplace.
  Your grievance was researched. Please be advised that we have forwarded your request to
  our ****************************** leadership to no longer be called at *************.
  Our records have been updated with your phone number ************* placed on our Do
  Not Call (DNC) list.
  We would like to thank you for taking the time to call/write about your experience. Direct
  feedback from our members is very important and helps us improve. We apologize for
  any trouble this may have caused you.
  If you have questions, please call Molina Healthcare at ************** (TTY 711)
  Monday through Friday from 7:30 a.m. to 6:30 p.m.
  Sincerely,
  ************
  Appeals and Grievances, Specialist
  Molina Healthcare of Washington

• Initial Complaint

  02/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  After waiting months to have surgery on my shoulder...a week before my surgery, my surgeon called and told me that they had to cancel my surgery because Molina would not reimburse **************** enough for a portion of my surgery. This company does not understand that their decisions to make more money affects REAL PEOPLE. I am in pain 24 hours a day, 7 days a week from a total AC Joint Separation and Molina Healthcare literally told me 'sorry, there is nothing we can do'.

  Business response

  02/16/2024

  Issue resolved with member over the phone. The provider is not participating with this plan and as such requires authorization. No further information can be provided as per HIPAA.

• Initial Complaint

  01/24/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Molina was billed for service I have received but won't pay the balance although I was covered during the time frame in question. Molina has been paid a retroactive payment to ensure the bill could be successfully submitted. They have been uncooperative regardless of payment and I the customer have been held liable to pay for a service I was covered with healthcare. I've contacted the billing compliant **** as well and trying to open a hearing to resolve this matter. All efforts are going ignored and this business is unfair and unreliable in a time of need even after they have received payment

  Business response

  02/01/2024

  Hello,

  The coverage for (**********************) was reflecting the records of Washington Healthcare Authority. It was confirmed that updates were made to allow active coverage from (05/01/2020-06/30/2021) and again (07/01/2021-12/31/2023).

  Molina Healthcare made the appropriate changes in these eligibility segments to reflect active coverage. We discovered several provider/ physician claims on file during these date spans, that required Adjustment. We have since sent the claims to be adjusted, which will take ***** days for processing and for the provider(s) to receive payment information. We have already contacted the provider/ physician group (MULTICARE HEALTH SYSTEM) that (**********************) was receiving active billing notices from. This provider group (MULTICARE HEALTH SYSTEM) advised they have notated their records and requested that (**********************) disregard the bill.

  We have provided this information to (**********************) and given information about their right as a ******** recipient for balance billing. We have provided them with contact information for Molina Healthcare, if they continue to experience issues with their provider group.

  Thank you, for the opportunity to address this concern. If you have any questions regarding this information, please do not hesitate to contact back.

  -Autumn H. | Specialist, Member Appeals and Grievances | Molina Healthcare of Washington, ********

• Initial Complaint

  12/20/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  They have always had an issue with trying to add a primary insurance. There isnt one. They usually remove it same day. Dec 7 I started getting denials of claims. An agent filed to have it looked into but never actually turned it in. My son had major surgery and they are covering nothing. They say we have some other health care coverage. We do not. Their representative a supervisor called with me on the line, to this insurance place the supposed to have verified coverage thru. I gave ALL my information they dont even do insurance! They are a pension company! Its been weeks no resolution no nothing. I have kids running out of medicine, kids that need to be in physical therapy. They cant keep a straight story, they cant get the name of this imaginary insurance. They are rude when you try to get help. They just basically say too bad! I have spoken to apple health who says no other insurance is on me or my children. They pay my premiums. They really need to get it together.

  Business response

  01/16/2024

  Thank You for bringing this *** issue to our attention regarding our members *********************** and her children. We have reviewed all of their accounts including the accounts of all of Mrs. ***** children and it appears that we are showing the *** ZENNITH ADMIINISTRATORS as active within her account and most of her childrens accounts from 11/01/2023 through 11/30/2023. We are now also showing the *** as being reinstated within their accounts from 01/01/2024 01/31/2024. This issue was escalated to our enrollments department to address, and we were able to successfully connect with a representative at Zennith Administrators who confirmed that ************* and her children were active from 11/01/2023 11/30/2023 and that their coverage was reinstated on 01/01/2024 01/31/2024. I have contacted ************* and advised her of this, and at this time she is also going to contact ******* Administrators directly to get the proper documentation and ID cards as she was not aware of this primary coverage for her and her children. We will also be addressing any claims that have *** have been affected due to this ***. Thank you again for allowing us to address this issue. Please let me know if you have any questions or need anything further.
  

  Attached is the letter we also sent to **************

  Below are the names of the children who's accounts had primary insurance that we have updated.
  

  ****************** W
  ****, HYNTER J
  ************************ L
  ****, ******** S
  LITTLE, LYLEAH E
  ****************************** D
  
  Thank You,

• Initial Complaint

  10/05/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Without a doubt, Molina is the worst insurance my family has ever had. Im paying over $1300 a month, for their Gold plan (for 3 people), and they would deny us oxygen to breathe if they thought it would save them money. I had a severe ear infection at the beginning of the year and my doctor prescribed me Tetracycline, literally the only antibiotic that I am not allergic too, and Molina denied me that! I had to use the pharmacys discount card to get the medication instead. Every time I get a new prescription, they want to deny it. I recently had an MRI. Before I had the procedure, Swedish let me know that Molina was charging a co-pay of $302.71 and they gave me 10% off if I paid it before. Then, AFTER the **** ******* sends me a bill for an additional $176.58! That is textbook BAIT and SWITCH; completely illegal! We were on the phone today for over an hour with Molina and went nowhere. They said that the original quote was from their cost estimator that they give to providers. So, their cost estimator is 63% off? That is absolutely ridiculous and an unfair business practice. They need to stick to the co-pay that their "cost estimator" quoted Swedish and take this off my bill. If this does not get resolved on the BBB, the next stop is the Attorney General and local media!

  Customer response

  10/05/2023

  I'm not sure what happened but I did not intend to click "repair issues".  Can we edit that?

  Business response

  10/16/2023

  We have reviewed the claim in question and have determined that the cost share applied is correct as per your plan and the services rendered. Providers can only provide an estimate cost share and they do not have access to your out-of-pocket accumulations, so a completely accurate guess is not always guaranteed. Unfortunately, Molina can only estimate cost share to a certain degree as it is based on what services are rendered and how the provider bills those services, which are not known until the provider submits a claim to Molina for processing.

  Customer response

  10/17/2023

   
  Complaint: 20700738
  
  I am rejecting this response because:

  Molina provided Swedish with the calculator to assess pricing. If their own calculator is off by almost double then they need to adhere to their original quote. In any other industry, you cannot quote one price and then charge another; that's bait and switch and highly illegal. Molina needs to honor their original quote.
  
  Sincerely,
  
  *********************

• Initial Complaint

  04/17/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  After receiving countless emails about Molinas HealthPerks $50 bonus for completing a wellness assessment as well as annual exam, I completed both requirements in December 2022. At the end of January, I had not received the bonus or any indication it was pending so I reached out to support via the MyMolina webpage. I was told that it takes 60 to process and reach back out then. At the end of February/60 days I reached out again and was told it is a 90 day process. At the start of this month/100 day ***** I reached out again and was told they are not the people to contact and I should log in to MyMolina for more information. I reminded the support person I am logged in to MyMolina and nothing is showing up. They said they could not assist any further and gave a general phone number for Molina Wellness that has gone straight to voicemail for weeks with no returned calls. I want the $50 bonus for completing the steps for 2022 as Molina instructed as well as confirmation that my recent completion of these steps for 2023 indicates I will be receiving an additional $50.

  Business response

  04/28/2023

  The member has been informed that after a review of the account, the necessary actions to receive this incentive have not yet been completed for 2022 or 2023. 

  Customer response

  05/02/2023

   
  Complaint: 19944711
  
  I am rejecting this response because: I have completed the required steps which Molina claims I have not. Here is the proof. I have attached the only Molina messages outlining instructions on how to obtain the $50 bonus, the main part of which is copy and pasted below:
  "Molina has launched its new wellness program called My Health Perks. Through My Health Perks, you and every adult covered on your health plan are eligible to earn a $50 gift card for completing the two steps below.
  
  1. Complete the designated My Health Perks Molina Wellness Assessment.
  
  2. Visit your ******* Care Provider (PCP) for your annual Wellness Examination."
  

  I have also attached documents that indicate completion of the Wellness assessment on 12/10/22 and 1/12/23. I have also attached confirmation of attendance at 2 annual wellness visits on 12/15/22 and 3/31/23. Please show me where I have not completed the requirements as I have provided evidence that they have been.
  
  Sincerely,
  
  ***********************************

  Business response

  05/11/2023

  This letter is in response to your grievance Molina Healthcare received on 05/08/2023.  Your grievance is regarding the redemption of your MyMolina Wellness $50 gift card reward.

  
  Your grievance was researched. According to our records the requirement for an annual routine wellness exam has not been met for 2022 or 2023 as of today 5/11/2023. Our records reflect that the services billed on dates of service 12/15/2022 and 3/31/2023 were for a general office visit and were not billed as a wellness exam visit using the before mentioned codes specific to that service. Please be advised that to be eligible for your My Health Perks wellness program reward an annual routine wellness exam with your ******* Care Provider (PCP) and a Health Risk Assessment (HRA) must be completed. When both tasks are complete you will earn 25 reward points for each activity to redeem for your wellness incentive.Please be advised that your provider may call our contact center for more information or assistance with submitting a claim.

   We would like to thank you for taking the time to call/write about your experience. Direct feedback from our members is very important and helps ** improve.  We apologize for any trouble this may have caused you.
  
  If you have questions, please call Molina Healthcare at ************** (TTY 711) Monday through Friday from 7:30 a.m. to 6:30 p.m.

  Customer response

  05/15/2023

   
  Complaint: 19944711
  
  I am rejecting this response because: Molina has retroactively changed reward instructions after I, as a patient/customer, did everything in my power to complete the two instructions in their only form that was made available to customers- Complete the Health Perks Questionnaire and Attend an Annual Wellness Exam. You have acknowledged I completely the Health Perks which I genuinely appreciate as it took 4 months for numerous support people to confirm that much. As far as attending an Annual Wellness  Exam, this is the type of appointment I booked with each provider via their booking portals. If having a specific *** code was a requirement, why was it not included in the instructions? Even if it were, in what world does a patient dictate how a provider/organization bills services? Truly I'm curious, at what point in an appointment does Molina think it is appropriate for a patient to tell the doctor how to do their job? By making this requirement about a technicality with *** codes, you are revealing what Molina is at its core, a bad faith operation. It is bad faith to inform customers of instructions and then add specificity to those instructions after they have been completed sufficiently according to the first instructions you provided. That's the definition of reneging. If Molina actually cared about the mission of the initiate, to encourage annual wellness exams, it would not care about the *** code. 

• Initial Complaint

  03/27/2023

  Complaint Type:

  Product Issues

  Status:

  Unanswered

  More info

  I have called Molina multiple times for a refund on my account just to be told that the refund has been posted and that it will be escalated. Each time I call them they tell me the same thing that I should get it in a couple of business days and that they will escalate it again. They have also told to me to send them statements of my accounts to make sure I didn't receive the refund from them; I sent them the statements with no response from them. Fast forward several months and several escalations, I am still waiting for my refund. To top it off, I can no longer seem to get a hold of the company with my account number. I'm owed around $417 from this company that could've been used to pay my bills. Overall, my experience with Molina has been terrible.

• Initial Complaint

  02/06/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Unanswered

  More info

  ***************************** at ****** ********************** in ****** requested a ** scan of the head that was unnecessary to rule out any abnormalities that *** be causing my migraines. If the doctor had looked more closely at my records, I was prescribed a medication for migraines. Molina is assuming that the head scan was done for my nausea, stomach issues ( I did not have a complaint at the time for either symptoms). Now Molina is trying to have me pay for a procedure that was not unnecessary. I cannot afford such a expense that is not covered under my insurance. I have filed an appeal with Molina in the hopes that they will see fit to cover the ** scan and that in the future no other scans like this will not be requested in an emergency situation.

• Initial Complaint

  12/16/2022

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  Molinas Billing and ********************** decided to arbitrarily charge my **** account $334.66 for a mistake that they made. They withdrew a sum of money that was not approved, which borders on fraud. Ive provided bank statements proving that Im paid in full. Additionally, I spent over 6 hours on the phone with Molinas own Analysts who agree that the mistake was made by Molina. Unfortunately, the Analysts are not empowered to correct the mistake. Empty promises that a check will be sent in the mail are followed by weeks of waiting only to find out that a check was never issued and that the issue it still being reviewed by the escalation department. Beware that some if not all of Molinas internal processes are bordering on incompetence. Be especially cautious about setting up auto payment with Molina lest you end up paying more than was agreed to in the contract.

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