Complaints

This profile includes complaints for Hawaii Medical Service Association's headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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  Hawaii Medical Service Association

  818 Keeaumoku St Honolulu, HI 96814-2393

  
• 

  Hawaii Medical Service Association

  33 Lono Ave Ste 350 Kahului, HI 96732

  
• 

  Hawaii Medical Service Association

  4366 Kukui Grove St Ste 103 Lihue, HI 96766

  
• 

  Hawaii Medical Service Association

  75-1029 Henry St Ste 301 Kailua Kona, HI 96740

  
• 

  Hawaii Medical Service Association

  1132 Kuala St STE 400 Pearl City, HI 96782

  

The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

• Initial Complaint

  Date:10/30/2023

  Type:Product Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I have been trying to contact HMSA's customer ********************** for the past 2 business days. No one answers their lines, I am on hold for over an hour and when using their "call-back" feature, they never call me back.I previously spoke with customer **********************, ****, on 9/29/23, to clarify why HMSA had not paid my dermatologist's bill from July 2023. **** stated it was because they needed my primary insurance information. I gave her this information and she stated she would be reprocessing the claim and it should be paid within 1-2 weeks. It was never paid. I paid my doctor myself and will expect HMSA to reimburse me for this claim.I received another member statement from HMSA dated 10/14/23 stating they needed to know how much my primary insurance paid to my dental office for surgical services I received on 8/21/23 before they would make any payment on claims.WHY AM I DOING THEIR JOB FOR THEM??? They already know that ***** is my primary insurer. Should they not contact Aetna directly if they need any further information to process any of my medical claims filed by my medical providers??? Or, can they not contact my medical providers directly to obtain whatever information they need to complete my claim???I am totally embarrassed with my medical providers not being paid on time. Totally unprofessional! I will hold HMSA responsible if my credit rating is ruined for delinquent bill payments to my medical providers.Also, when I call, why do I have to wait hours for someone to answer...or never answer!

  

  Business Response

  Date: 10/31/2023

   

  Thank you for contacting the BBB with this issue. 
  
  HMSA is working hard to fill all our servicing positions with quality, local representatives.  We are committed to regain our previous servicing performance levels of an average of five minutes or less.  We also have an on-line inquiry service available on HMSA.com for you to send an e-mail to our servicing center as another option.   I will have a representative contact you, regarding your claims issue.

  We apologize for the frustration and inconvenience you encountered. 

  
  *********************** - Customer Relations Manager 

• Initial Complaint

  Date:10/30/2023

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  My ******** Care Provider recommended, that I attend outpatient diabetes classes at Queens West. The referral was approved according to HMSA and I eligible under my health insurance plan. 4 classes were scheduled. Dates and instructors are as follows:8-03-2023 Instructor *************************** 8-10-2023 Instructor *********************** 8-17-2023 Instructor *************************** 8-24-2023 Instructor *************************** However, HMSA only paid in full for the second class with *********************** My first visit to Pearl **** HMSA I was told by a HMSA rep. that they will contact claims to expedite payment, since I am covered under my plan.On my second visit to HMSA I was told my other instructor *************************** was not a certified practitioner on HMSA's list of providers. Speaking with my providers administration person *************************** has many ID' numbers with ********************** and many of her patients have filed claims with HMSA with no problems. The HMSA rep. will expedite a correction to claims dpt.On my third visit, the HMSA rep could not answer why they are not paying my claims from *************************** and told me she would expedite correction for payment and call me back to follow up. No follow up at this time.My outpatient admin. told me not to pay till they can figure out why HMSA claims are not processing. In the meantime, I am receiving late payment notices from my outpatient provider. I asked HMSA rep. at the kiosk to speak with someone who can help me but was told there is no one else except the reps at the kiosk at HMSA . There seems to be a lack of communication between HMSA reps and the Claims Department.Please help me to resolve this confusing and frustrating situation. Thank you for your help,*****************************

  

  Business Response

  Date: 10/31/2023

   

  Thank you for contacting the BBB with this issue. 
  
  HMSA  also has an on-line inquiry service available on HMSA.com for you to send an e-mail to our servicing center as another option, besides calling our Contact Center.   I will have a representative contact you, regarding your claims issue and provide you an update. 

  We apologize for the frustration and inconvenience you encountered. 
  
  ************************ - Customer Relations Manager 

  Customer Answer

  Date: 11/05/2023

  Aloha. 
  Quick update,

  HMSA called to inform me that they have contacted the Queens accounting department to try and get some information. They also reported that they are reprocessing my claim. They said they will contact me when Queens replies to there inquiry. However no further contact at this time.

  Customer Answer

  Date: 11/15/2023

  Aloha,

  I received 1 phone call from Grace *********************** about 2weeks ago. She told me they are reprocessing my claim. However I am still receiving late payment notices from ***********. Then 2 days ago I received a Report to Member from HMSA that I do not qualify for my outpatient service. And I still owe my RPN ****** for August 3rd 2023. Please reopen this case. Thank you *********************;

  

  Business Response

  Date: 12/07/2023

   

  I contacted *******************, who is working these claims and she states, "the member actually returned my call on 12/1.  He appreciated the information and diligence Im doing in getting these claims paid.  I increased priority to reprocess these claims and I am tracking and monitoring these claims for payment"   

  I am unsure at this time which claims are still in question or being reviewed. 

  If you could please contact me in person so that we can discuss this in person.

  ********************* - ************ 

  Thank you

   

  Customer Answer

  Date: 12/18/2023

  I would like to keep this case open. They still are in the process of getting my account paid in full. I was told that 2 claims have been paid and 2 still needs payment. My concern is that the reminders for payment keep coming from *********** and the possibility of the bill going to collections. My other concern is if my credit rating will be affected and if so how is HMSA going to correct any adverse affect on my credit report. Patience is very thin at this time as someone or something is terribly wrong with this process 

  

  Business Response

  Date: 01/19/2024

   

  Reviewing the four claims identified by ******************, I do show that all four claims have been paid, the last claim being paid 1/18/2024.

  I apologize for the delays and confusion regarding the provider's HMSA claims filing provider number.   

  I will contact you to discuss any additional concerns.

  Thank you - *********************;

   

  Customer Answer

  Date: 01/20/2024

  Aloha, 

  I was contacted by HMSA and was told that my 4 claims at *********** had been paid. However I still show my on my Queens billing statement as still not paid. I will wait a few days to see if they update my billing statement.

  thank you 

  i will contact you in a few days

  Customer Answer

  Date: 02/01/2024

  Aloha,

  I apologize, that you did not receive my last message. This is getting more bizarre the more I question the process.

  After receiving confirmation from 2 HMSA representatives, that my claims have been paid I still have an outstanding balance from *********** for my outpatient diabetes class.

  I called Billing at *********** and they confirmed my outstanding balance not paid by HMSA

  Queens billing rep told me she was going to call my contact at HMSA so I am waiting for the contact outcome. 

  I called my Contact at HMSA if she talked to ************************* and she said  Queens had called her but they are playing phone tag because they have not spoken yet. 

  IN THE MEANTIME, can you sense the frustration with this situation.

  Question is there any legal action that I can take to settle this issue?  In the meantime my credit score suffers because of late and outstanding payment that HMSA should have paid back in August of 2023.

  Customer Answer

  Date: 02/08/2024

  This complaint has not been resolved according the *********** billing department. I have one more outstanding payment to make for *******************************. HMSA is telling me everything is paid but Queens billing says HMSA still denies the claim that's why they keep sending me bills and is telling me it will go to collections because of the overdue payment. I gave Queens billing department my 2 contact people at HMSA and no one has gotten back to me regarding a resolution to this issue. Contact people at HMSA is ********************* City and ***** at ****************** Contact at Queens is whoever answers the phone. I spoke to a *** and Mahea at ***********. If HMSA can resolve their issues regarding payment of my claim then Queens can get paid properly. Nobody at HMSA seems to know anything about resolving this issue. According to their HMSA's report all is paid but ****** tells me that the claim is denied. And so the bills keep coming. I would pay this just to get it taken care of but what's the use of having medical insurance if they will not pay a legitimate claim. I just don't understand. And another frustrating issue is that their is no one higher in authority I am told, that can help me resolve this issue.  

  

  Business Response

  Date: 02/21/2024

   

  Queens is refiling the claims for 8/3, 8/17 and 8/24/23 with the correct provider number specifically for Diabetes Education.  Once the claims are received, they will be expedited. 

  ********************* - Manager HMSA Customer Relations 

  Customer Answer

  Date: 02/21/2024

   
  Complaint: 20798342
  
  I am rejecting this response because: There is no follow up when things actually get corrected.  When there is a response it is usually not correct. It seems like no one knows what to do at HMSA. ****** keeps sending late notices to me and even threatens.to send my bill to the collectors. My credit score *** suffer from HMSA's lack of follow up and ability to correct this issue. This has been going on since August of 2023. I have called Queens billing **** and they are very helpful but cannot stop the bill notices from being sent to me. My last late notice I called billing at Queens and they offered to extend my late notice being that I am having issues with HMSA. I have to keep calling everytime my bill comes up for payment or it gets sent to collections. Queens cannot correct the issue because it is HMSA that keeps denying the claim. I woluld like Queens to contact me when and if HMSA corrects this issue. 
  
  Sincerely,
  
  *****************************

• Initial Complaint

  Date:10/11/2023

  Type:Order Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I pay into my health insurance and cant even get someone to answer my phone call to request my pcp on my account so my pcp can send a referral out to a specialist so I can see someone about my pain. I had 3, 2 hour on hold waiting for someone to answer and ended up getting hung up on due to a processing system. Why cant someone answer so I can get my doctors appointments!

  

  Business Response

  Date: 10/19/2023

  Thank you for contacting the BBB with this issue. 

  
  HMSA is working hard to fill all our servicing positions with quality, local representatives.  We are committed to regain our previous servicing performance levels of an average of five minutes or less.  We also have an on-line inquiry service available on HMSA.com for you to send an e-mail to our servicing center as another option.   I will have a representative contact you. 

  We apologize for the frustration and inconvenience you encountered. 

  ************************ - Customer Relations Manager 

• Initial Complaint

  Date:10/05/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I unexpectedly received a new HMSA card in the mail. The letter does not state the company the card is in reference to or what date it in effect, I tried calling numerous umber on numerous days to get information on these and was consistently told waiting times would be 60 mins, 125 mins, 48 mins and 36 mins. I am on HOLD right now while filing this complaint. The recording told me to expect a waiting time of 22 minutes, Right now, I have been holding for 1hr. 28 minutes. I have seen comments and responses from HMSA on this issue. The fact that nothing has been done to correct this situations show complete arrogance and disregard for their customers. Inexcusable.

  

  Business Response

  Date: 10/06/2023

  Thank you for contacting the BBB with this issue. 

  HMSA is working hard to fill all our servicing positions with quality, local representatives.  We are committed to regain our previous servicing performance levels of an average of five minutes or less.  We also have an on-line inquiry service available on HMSA.com for you to send an e-mail to our servicing center as another option. 

  We apologize for the frustration and inconvenience you encountered. 

  ************************ - Customer Relations Manager 

   

   

• Initial Complaint

  Date:09/25/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Called the ***************** to inquire how I go about how to get my medical travel expenses paid for. Was told that all I had to do was have my doctors off submit a request and I can go ahead and make my arrangements. Then when I called to follow up was told I dont qualify for reimbursement because of my Quest benefits and that Quest should have contacted me. I was not told any of this at my original inquiry if I had Quest I have to go through them. Been trying to resolve with HMSA travel as I had to pay out of pocket for my trip because I was not informed correctly. Also because I did Not receive any phone call from Quest that they had scheduled my flights and took care of my arrangements. Its been an on going conversation with HMSA that has not been resolved

  Customer Answer

  Date: 09/26/2023

  I also did not receive any formal letter in writing of denial for their travel program as stated on their website. I also did not receive any information from the ***************** that I would have to use my Quest benefits. I never received a call from them as well to schedule any flights, etc. when I spoke with them, I was told that my Care Coordinator was supposed to communicate with me, but that did not happen at all. 
  I spoke to the travel department yesterday and they are saying everything is my fault because things are documented on their end. Also that they know nothing about the Care Assistance Program because its a commercial plan issue. Been getting transferred to the same department and not getting any decent response for the s**** ** in their end

  

  Business Response

  Date: 10/06/2023

  On 9/26//23 I sent an email to our member - 

  
  On Sep 26, 2023, at 11:13 AM,********************* <**************************************>wrote:
  
  Thank you for your inquiry sent to the BBB.
  
  I will be working with you to resolve this issue.
  
  If you could please send me the receipts, claims or information outlining the specific travel expenses that you paid for and seeking reimbursement.  You can email me copies of these receipts,
  
  **************************************   and my direct telephone number is listed below ************.
  
  Thank you - *****
  

  Ok. Im working on getting a copy of the receipt since I only have the itinerary with the cost of the flight but not the entire cost paid
  Sent from my iPhone

  *********************** <*********************************>

   

  On 9/27/23 received reply and copy of receipt

  Hi *****,
  Is a copy of my travel receipt.
  Thanks, 
  *****

  Sent from my iPhone

  *********************** <*********************************>

   

  We are currently reviewing this case.

  ***** Unger 

   

  Customer Answer

  Date: 10/19/2023

  This case has not been resolved and I have not received any communication from the business

  

  Business Response

  Date: 11/09/2023

   

  Our HMSA Member Advocacy and Appeals unit has been working directly with *****************  They have spoken directly with the member twice and have file a Grievance on her behalf. 
  
  What additional information or action is being requested by the BBB?
  
  Thank you *********************

• Initial Complaint

  Date:07/31/2023

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  On many occasions when I call HMSA to ask questions about my coverage, I have been on hold between 45 minutes to over an hour just to ask about my coverage. This is ridiculous. This is what happens when a nonprofit agency bosses take bonuses and cuts services to its members. HMSA needs to have a customer call back system and monitor it since HMSA's phone system tells consumers the wait time. The information is way off base. I was last told 32 minutes. I was on hold for 48 minutes. Ridiculous. HMSA really needs to hire more people.

  

  Business Response

  Date: 07/31/2023

   

  Thank you for sharing your servicing concerns with me.  

  I am *********************, one of the managers for our Customer Relations contact center.  I apologize for the long hold times you have experienced.  I am aware of our poor performance and member accessibility issues and I am not proud and I know that we need to perform better.  We continue to hire and train additional representatives and put in place workflows to improve our accessibility and reduce our hold times for members.   My direct telephone number is ************  and I can assist, and I will also call you.

  *********************;

   

• Initial Complaint

  Date:05/30/2023

  Type:Service or Repair Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  In January of this year I turned in a claim seeking reimbursement for three doctors appointments with my same usual doctor with some of the same existing health issues, which are ongoing, that *** previously received reimbursement from HMSA for and this has been over the last several years. Nothing new. What is new is that HMSA is deciding theyre just not going to pay. Theres also been some additional health issues that were also included as I had a hospital stay which involved surgery and was told to follow up with my regular doctor to check to go over some things that wouldnt be addressed with the doctor who performed my surgery. About a month after I turned over my claim HMSA rejected it for all three doctors visits and the reason given was it was a service that had already been paid. I called them that same day and spoke to *** to find out why and just how this was supposedly already paid for and she was unable to tell me anything more. When I insisted that this is a valid claim and would turn them in to the BBB she said it would be resubmitted and Id have to wait another ***** days to find out the results. Its now been more than 90 days and not one word. HMSA is scamming their customers and someone needs to hold them accountable! This is fraud!

  

  Business Response

  Date: 05/30/2023

   

  Will contact the member to confirm the service dates and assist with the review, research and resolution of this inquiry. 

  ********************* - Manager of Customer Relations

  ************

   

   

• Initial Complaint

  Date:03/24/2023

  Type:Product Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I was out of the country when I incurred an injury on June 12,2022 that required an emergency center visit, hospitalization and surgery and rehabilitation. After I returned to Hawaii on July 12, 2022 I filled out the reimbursement claim application and mailed it to HMSA on or about the 20th. Since I read somewhere on the HMSA website that these claims take 3 to 6 months to be processed, I waited until January 20, 2023 to call them on the status; I was told to call back at the end of February. Since that initial call, I called 5 times for status updates and was told 5 times that they would call me back but I received no calls. I called again on March 20 and was told that I would receive a callback. Unbelievably a manager from the Customer Relations section called me back that day and he told me he would look into my problem. I called today (March 24), left a message and as of 4:05 pm I am still waiting for a return call. I understand that HMSA has many claims to process but confusion about where in the chain my claim sits and not returning calls is non-professional and bad customer **********************. In the meantime, I am waiting for my reimbursement to pay bills.

  

  Business Response

  Date: 03/27/2023

  I was able to speak to the member on Thursday, March 23rd to gather information regarding the delay of the receipts he submitted for services received out of country.  I was out of the office on Friday, March 24th, but I did call ********************** back this morning.  

  I am working with our ********************* to expedite the processing and reimbursement of his claims and will work directly with the member.  

  Thank you - *********************

   

   

  Customer Answer

  Date: 03/28/2023

   
  Complaint: 19850977
  
  I am rejecting this response because: ************** said that he talked to me on Thursday, March 23 and he absolutely did not.  I texted him on that day and did not receive a response; that is why I called on the 24th.
  
  Sincerely,
  
  ***************************

  

  Business Response

  Date: 03/28/2023

  I apologize and stand corrected, my initial call to ********************** was on March 20th, as he stated in his original Statement of the Problem. 

  The telephone number I provided to ********************** is my office number and I did receive his telephone message on Friday, March 24th, while I was out of the office.   I did not receive a text or e-mail. 

  I did follow up with ********************** on Monday, March 27th, when I returned to work and also today, Tuesday, March 28th.   I provided him confirmation that the claim for service date 6/12/2022 for $56.68, paid $38.35 on March 22, 2023, which he stated he did receive.  I also advised him the remaining claim for service dates 6/13 - 7/7/2022 would be complete processing for member reimbursement by April 7, 2023.   

  I will continue to monitor and track this claim until it is resolved.   The member has my telephone number for any additional questions.

  Thank you - *********************;

   

  Customer Answer

  Date: 03/29/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***************************

• Initial Complaint

  Date:03/03/2023

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  I am a nurse practitioner who has served the Big Island and have been an HMSA provider for 24 years. I called HMSA in November 2022 to cancel my PPO policy as I qualify for ******** due to my age. At the time, I was told "no problem." I kept getting large bills for premiums into January 2023. I called HMSA and was, this time, informed I had to cancel the policy through the ******************* exchange. At no time during enrollment or cancellation wa sthsi mentioned previosuly. I disenrolled immediately but kept getting large bills from HMSA. I was told that the entire erronous bill would be forgotten but was now getting ******* notices. This is led to a series of calls to HMSA and an unpleasant letters authored by a ************* (enrollment specialist) dated in Valentine's *** 2023. I left meaasges for *********** which he did not anaswer. I eventually reached him deuring my busy clincal schedule and he interreupted, talked over, contradicted me and raised his voice for twenty minutes. he iterrogated me like I was a ***, rather than a seasoned provoder or respected member. I left messages for his superior who did not repsond. It is very diffcult spending my breaks from pateint care trying to reoslve their mistake. Please help me

  

  Business Response

  Date: 03/08/2023

  Thank you for bringing this to my attention. 

  I am researching and working with our HMSA ********************* to gather information to resolve this issues.  Please allow me 7 - 10 business days to complete this research and I will respond and provide follow-up. 

  **********;

   

   

  Customer Answer

  Date: 03/08/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me for the moment. The unwarranted charges still need to be resolved. 
  
  Sincerely,
  
  ***************************

• Initial Complaint

  Date:12/22/2022

  Type:Customer Service Issues
  Status:

  AnsweredMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  HMSA billing delays processing of my doctor visit claims to include visits to ****** (prime) hospital. HMSA is my secondary insurance from my spouse and they do not provide any health care for me with exception to the dental portion of my spouse plan coverage. Since I have a third insurance with Tricare the ****** and HMSA process is mitigated first before Tricare receives the bill for any payment. *** tried to lean forward to resolve overdue billing from ****** clearly due to issues with the processing of billing by HMSA. Problem: HMSA claims have provided me with checks that they have admitted these were made in error. Since these checks are not valid and their lack of providing EOB to correct these errors, significant delays processing of my claim to clear ****** and to allow the next step sent to Tricare jeopardizes my credit with overdue bills. Numerous calls with hours on phone have not resolved issue with HMSA continuing for over 9 months. HMSA continues sending checks to me. As my ********************* is delayed and billing threats for final warning results from HMSAs absurd lack of responsible processing. Even after receiving assurance that someone from HMSA will contact me to resolve the claims errors by adjusting denial of payment to ****** versus why a check is made in lieu of the denial. Either way my ********************* is delayed due to HMSAs lack of action and is the reason I have an issue if it goes to collections.

  

  Business Response

  Date: 12/22/2022

   

   *********************;

   DOB  3/3/1959

  *********************

  DOB 3/3/1959

  R000027860428-02

   

  I am acknowledging receipt of the BBB complaint and will be working with our ***************** to gather additional information related to the incorrect checks, delays and our HMSA Report to Member.  I will also contact the member to gather information to help with the research.

   

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  Customer Answer

  Date: 12/27/2022

   
  Complaint: 18627470
  
  I am rejecting this response because: no response to resolve. I am currently receiving late billing payments from ****** due to HMSAs ability to provide action to clear second insurance rejection in order for payments to be sent to third party Tricare insurance. 
  
  Sincerely,
  
  *********************

  

  Business Response

  Date: 01/12/2023

  I continue to work with our ********************* area to implement a manual review process for ****************** claims to prevent any additional incorrect, processing and generation of checks.  We are also researching why there was a change from the previous, correct denials of services from ****** to the sudden beginning of paying the claims. I have spoken to ************** a couple times and he has sent me email copies of recent checks he received.  I will continue to work with him directly. 

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