ComplaintsforDean Health Plan
Health
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Complaint Details
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Initial Complaint
06/21/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
My dad passed away on 10/15/23. He was a ***************** member for 20 years, always paid. After his death **** took an extra payment from him by mistake. I called **** to inquire in late October and they said they did not take the payment. I then received a letter from **** from 2/29/24 stating that they had taken the payment and had attempted to issue a refund check. The check was mailed to my dads old address and not forwarded on to my address. However, there is zero evidence that the check was ever mailed by ****. The address it was mailed to never received it. I contacted **** and had them reissue the check to me at my address in *******. After two weeks I called **** and asked about the check. They had mistakenly sent it to my dads address for the second time. It was voided and they attempted to send the third check to me in *******. This was in May. The check never arrived. I contacted **** and they once again voided the check. At this point I asked if I could just come and obtain the check myself. I was told that I could not do this and that the check would be mailed. I called back and spoke to a different rep who told me that I could in fact come to **** and pick up the check. On 6/10 I received a message from **** asking for the date to come and pick up the check. I told them the week of the 17th but I would aim for Thursday. I ended up being able to come earlier on Tuesday and arrived to receive the check. I was told they were not sure where the check was and asked to wait. I had run out of patience at this point after dozens of calls with zero accountability and I left. I called **** on my 2 1/2 hour drive home and spoke to *************************, a supervisor. She had zero empathy for the situation and said the check would be mailed the following day. I was not allowed to come back to pick up the check or send someone. She said she would call when it mailed. She didnt. I just called on 6/21 and ****** would not take my call. The check was mailed yesterday.Business response
07/02/2024
Dean Health Plan does not have authorization to disclose information regarding this issue. Dean Health Plan has received a complaint from the member representative and will be reviewed through our internal process.Initial Complaint
02/07/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
I have been a Dean Health Plan customer for many years. At the beginning of this year, **** merged with Medica. Since that time, the only information I have been able to receive about my plan has been payment requests--I cannot get to the portal to get my benefit information, and numerous calls have only yielded the same lack of information--promises to send via mail and email have gone unfulfilled. Many, many calls have just put me in the same position--expected to pay for a policy where I have no access to benefit information at all. Employees are clearly frustrated and I cannot continue to waste time and be told over and over I should see it all fixed within a few days. First call was 5 weeks ago and was told a ticket would be put in and I would receive information. Grievances to the company have gone ignored.Business response
02/23/2024
The Health Plan has outreached to this member to discuss their concerns regarding the member portal and the information currently available. A copy of the member's Member Certificate has been shared via email as it is not currently available within the member portal.Initial Complaint
11/05/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I took my son to the doctor on 11/2/2023 due to having diarrhea and vomiting. After doing lab work tests came back as Cryptosporidium. The called me and informed me that the medication was going to be sent to the pharmacy for pick up. After going to the pharmacy, the pharmacist explained to me that the medication was going to have to a prior authorization, this was sent to my insurance company at that time. When contacting my physician, he informed me Nitazoxanide is the only medication there for Cryptosporidium. This the only *** approved medication. On Friday 11/3/2023, I sent a message around 9am asking if they received the prior authorization for nitazoxanide, it was not. I called at 3:30 that afternoon, again it was not approved. I called **** insurance company. After calling I was told I needed a prior authorization, I given a phone number for my physician's clinic to call the pharmacy directly at **** insurance. When my physician called, he was told that they would make this prior auth as urgently, it would still take 1 business day. The insurance company was told that my son needed this medication today because it is the only one that works for the infection. My son will be going on 5 days without being treated on 11/6/2023 because of the insurance company. How is this appropriate care for a sick child.Business response
11/10/2023
The Health Plan has quantity limits imposed on the requested medication, requiring a prior authorization be submitted and approved prior to the prescription claim can be processed. The Health Plan's pharmacy benefits manager, *******, initially received an incomplete request and had to coordinate with the requesting physician before being able to make a decision. Once the request was confirmed an authorization was granted and the prescription was able to be filled on November 6, 2023.Initial Complaint
04/19/2023
- Complaint Type:
- Service or Repair Issues
- Status:
- Unanswered
I canceled my healthcare.gov dean health plan policy at the beginning of Oct, 2022 to be effective 10/31/22 because I had new insurance starting on 11/1/2022.. I called **** to cancel and they said I need to cancel through Healthcare.gov. So I did. Now they are billing me for 1 day. Seems to be sloppy work from a new hire at Healthcare.gov who marked down the wrong date of termination; however, I called back to verify termination date and was told that it was 10/31/22 and I did not owe any money. I continued to receive bills from **** and was told by them that they could not do anything about this. Healthcre.gov and dean health plan failed me. No one is able to step up and take responsibility for their mistake.Initial Complaint
01/19/2023
- Complaint Type:
- Customer Service Issues
- Status:
- Answered
THIS IS MY 5TH REQUEST WITH NO RESPONSE FROM CUSTOMER **********************!!!! WHO DO I NEED TO SPEAK TO SO THIS CAN BE RESOLVED??? My name is ******************************* and I completed my first LIVING HEALTHY REWARD AND HAVE RECEIVED NOTHING. ACCORDING TO YOUR WEBSITE "*Delay in reward email(s) the first two weeks of January 2023. Rewards earned 1/1/23 - 1/11/23 will receive the reward email(s) on 1/12/2023." WHICH IS FINE BUT I STILL HAVE RECEIVED NOTHING! IT DIDN'T TAKE THIS LONG THE LAST 2 YEARS. I HAVE CHECKED MY SPAM FOLDER...NOTHING ACHIEVED REWARDS Achieved on 01/03/2023 500 $50 Gift CardBusiness response
01/31/2023
The Health Plan has outreached to this member to confirm rewards were appropriately distributed. Reward redemption emails were temporarily unable to be sent, however, functionality has been restored as of January 20, 2023.Initial Complaint
12/01/2022
- Complaint Type:
- Order Issues
- Status:
- Answered
Just turned 65 in November so whole month was covered under ******** and a **** Advantage Program. November 18th Call **** Healthcare about a bill for ****** for November and December.Talk with *************** at **** Health and ****** at Market place Also ******************************* *************) involved at **** Health She was in on the call to Marketplace.****** says that I was scheduled to end at end of November, and that it should of been end of October and that she'd fixed it and it was forwarded to another department for final processing, which could take a month November 30th Get letter from **** Health saying that I need to pay the November payment, which was also covered by the **** Advantage and ******** because I turned 65 in November.. Talked with ******** at **** Health, who transferred me to ******. ****** advise me that I need to pay it.File a Complaint with ********* at **** Health about this mess. She tells me to contact CMS and file an appeal there. Filed an appeal with CMS. Dec 01 Marketplace advise me that their response is final and I don't have the right to appeal this decision.Can't **** Health get it together and know that I was covered under ****************** and Cant the ******************** Market Place and ******** work together to know that I was covered for November. All I would like is $288.11 refunded to me for paying double for insurance in November from *********ThanksBusiness response
12/12/2022
The Health Plan has outreached to the member to advise of their right to file an appeal with the Health Plan and/or with the Marketplace.Initial Complaint
10/12/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Unresolved
Purchased health insurance through Marketplace with **** Health. When my new Employers policy was going to kick in I called **** Health to cancel policy. Their customer ********************** rep told me it would be canceled. I continued to receive statements for pass due. I called **** Health again and this time was told the only way to cancel was through Market place. I contacted Market Place and they canceled the policy 2/3 the way into the month. **** Health took Market Place payment and is trying to collect from me. I think them taking payment from the government is fraud and wanting payment from me is unethical. They have turned it over to a collection agency. On the top of there statement it said non payment would cause the policy to cancelBusiness response
10/21/2022
The member has been contacted and advised of the Health Plan's internal appeals and grievance process as well as the formal appeals process with the *** (Marketplace) as we are unable to honor the member's request within their complaint.Customer response
10/21/2022
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I called and canceled policy, was miss informed by their customer ********************** rep and did not use the insurance but yet they want to charge me. Not a reputable ********************************************************************************************Initial Complaint
07/28/2022
- Complaint Type:
- Billing Issues
- Status:
- Answered
Bait and Switch I have ********* HealthPlan. I got a large, expensive-to-produce, post card in the mail in April to get a FREE preventive visit. I tried to schedule a the FREE preventive visit. Apparently a FREE preventive visit does not include medication refills!!! so I got charged $60 for a different type of visit because I needed medication refills. I would like to be reimbursed the $60 I have paid to Prevea HealthCare in ********* because the FREE healthcare visit offered by ****/********* IMPLIES I can get healthcare and DOES NOT SAY I CAN'T GET PRESCRIPTION REFILLS. I would never have done the appointment at all if 1) it wasn't going to be free 2) I couldn't get prescriptions at the appointment. What a monumental waste of time. Stop being confusing and cheap. Didn't you get enough for me from the **** The federal government gave you about $750 every month for me and you cheap out on a basic appointment and are intentionally confusing.Business response
08/05/2022
********* Health Plan has reviewed this member's concern and has outreached by phone to confirm additional information so the next steps available can be provided. This concern relates not only to mailing information provided by the Health Plan, but also how the service provided to the member was billed to the Health Plan. Additional outreaches are scheduled if a return phone call is not made by the member.
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Customer Complaints Summary
8 total complaints in the last 3 years.
3 complaints closed in the last 12 months.