Complaints

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:01/13/2023

  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.

  January 27, 2022, my PCP submitted a billing claim form for a new patient/office visit. Ameriben entered this visit in their system as an annual/ preventative exam which I am only allowed one of a year. I did not realize that this error had occured until my OBGYN well women visit on May 18, 2022 was denied. Thinking this denial was an error, it was resubmitted in august with ameriben stating I already had an annual exam and denying it again. By this time it was too late to submit and appeal so my doctors office submitted a corrected claim from new patient to established patient in an attempt to reopen to claim and allow for correction. Thinking this would be corrected I submitted an appeal for my OBGYN and was denied. Turns out Ameriben disregarded the corrected form and processed it as a new claim which resulted in them paying my PCP twice for the same visit. I have had multiple phone conversations with claim representatives (october, november, december and january) who promise that this issue will be resolved and as of January 13, 2022, there has been no resolution. Ameriben is refusing to acknowledge the error and keep denying my appeals and/or emails from reps trying to clarify the claims. My OBGYN is now wanting to send me to collections because I refuse to pay a bill that my insurance should cover.

  Business Response

  Date: 01/24/2023

  Dear Resolution Specialist:
  Thank you for the opportunity to respond to complaint #********, received from **********************. In response to this inquiry AmeriBen would like to share the following information.
  AmeriBen re-examined the charges in question and the employer's plan document.  This additional review resulted in an adjustment to Ms. ********** claims.

  
  The original issue stems from the providers claim submissions.The initial claim for 1/27/22 was received on 2/4/22 with procedures/diagnosis that would appropriately apply to the annual exam 100% benefit. The claim for date of service 5/18/22 was received on 5/26/22 and appropriately denied as over plan *** for annual exam. The provider resubmitted the claim for 1/27/22 on 10/7/22 with a different total billed amount, a different procedure code and no indication that this was a corrected claim, thus, our system auto adjudicated the resubmitted claim as a new claim.

  
  In early January 2023, a request for review was received by our claims department via an email from the AmeriBen ************** Coordinator,which included a corrected bill for date of service 1/27/22. This email request resulted in the adjustment of both claims on 1/20/23; the 1/27/22 date of service claim has reprocessed under the normal plan benefit and the 5/18/22 date of service claim has reprocessed under the annual exam 100% benefit. The corrected explanations of benefit were issued on 1/24/23.  
  AmeriBen strives to address members concerns and properly pay eligible claims. However, we are required to apply the members plan benefits according to the providers submitted information. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.

  
  Sincerely,
  *****************************

  Customer Answer

  Date: 01/24/2023

   
  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:12/14/2022

  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.

  They provided different reasons for claim rejection and stated to provider that my coverage was expired when it was still in service. They failed to change the rejection claim. They never followed up after multiple phone calls to rectify this issue.

  Business Response

  Date: 12/30/2022

  Dear Resolution Specialist: 
  Thank you for the opportunity to respond to the complaint received from ****************. In response to this inquiry AmeriBen would like to share the following information. The assertion is that AmberiBen provided different reasons for claim rejections and that coverage had expired. ****************** employer used the services of AmeriBen, a third-party claims administrator, from June 23, 2019, to July 1, 2021. During that time **************** did contact AmeriBen regarding various claims and benefits. However, it was not until March 2022 that AmeriBen was contacted by **************** regarding claims in question. 

  
  AmeriBen has reviewed the claims in question and the employer's plan document that clearly delineates covered and non-covered benefits for its members. AmeriBen adjudicated the claims consistent with the claims as submitted by the provider and the terms of the employers plan document. At the time of claim denial, **************** was provided specific information regarding the claim in the Explanation of Benefits document she received. The information provided included both the reasons for the claim denial, that it was a non-covered benefit, and that she could appeal the claims determination. **************** did not elect to appeal the claims. Further, according to our records, **************** did not contact AmeriBen until after the claims period was closed.   
  

  While we appreciate that **************** is dissatisfied with the determination, it was not within AmeriBens control to change the terms of her coverage, nor how the services were billed by the provider. Unfortunately, at this time AmeriBen is unable to reopen the claims as the employer is no longer with AmeriBen and further, based upon the information we received, the claims were properly adjudicated.  

  AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.  
  
  Sincerely, 
  **************************;

  
  

  Customer Answer

  Date: 01/02/2023

   
  Complaint: 18572677
  
  I am rejecting this response because:
  

  I contacted Ameriben when I received notice that the claims were not paid due to them being incorrectly billed as family therapy. These bills were sent to me several months after the service and if I had known, I would have obviously contacted Ameriben sooner. I'm not sure what it matters if my first contact was in March, and I do not agree that it was this late, but is likely insignificant. After contacting Ameriben, about their claim denials, I contacted my provider, children's hospital, and CU medicine who then corrected the billing to correctly reflect that they were individual therapy and they resubmitted the claims. Ameriben then denied the claims  stating I did not have coverage at the time which is incorrect as I clearly did have coverage. I have contacted them multiple times and they say they will get back to me and never do. The last time I contacted them they stated it was conveniently too late for them to cover this bill. I have submitted statements of the bills with the corrected code and itemized documentation. Ameriben appears to have put me off repeatedly in order to avoid paying the claim and then provided incorrect information to the ****** to state I was not covered. 

  
  Sincerely,
  
  *************************

• Initial Complaint

  Date:12/04/2022

  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.

  AmeriBen assigned "member contact for health care admin" this year for my Anthem BCBS health insurance policy. Since then, my husband and I have had constant issues with bills not being covered correctly as in network, 100% covered visits not being covered 100%, and authorized items suddenly not being authorized. There is a discrepancy between what the oustanding deductible and out of pocket amounts are from AmeriBen to Anthem, causing providers to be charging incorrect amounts. When I call AmeriBen I receive different explanations from each rep. I even called AmeriBen once and the rep told me we all hate the Big Lots policy, it is so complicated to figure out. We have had multiple 3-way conversations between AmeriBen and the providers, with the providers stating everything was billed correctly, and AmeriBen comes up with ridiculous explanations for the excess charges. Several of the craziest have been that a 100% covered wellness annual visit only covers the office visit, not the urinalysis that is standard annual wellness visit procedure; and that an annual Pap smear is covered 100%, but that they didn't pay 100% to have the Pap test actually read. The hours and hours we have wasted contacting AmeriBen and these providers is ridiculous and has led to unhealthy stress levels from both my husband and I. Recent issues have led to almost $5000 in inaccurate medical bills. We are living in fear of these bills going into collections. I have attached a summary of these bills as well as the bills themselves. We need all of these bills fixed and all future insurance claims processed accurately.

  Business Response

  Date: 12/27/2022

  I reviewed our members 2 part complaint regarding herself and her spouse. Additionally, I reviewed all of the communication calls AmeriBen received and confirmed they were regarding medical benefits, eligibility and claim status. Neither member nor spouse ever submitted a request for appeal regarding any claim determinations.  Attached are details addressing the processing of the claims referenced in the complaint.  

  Customer Answer

  Date: 12/27/2022

   
  Complaint: 18522408
  
  I am rejecting this response because:

   

  I appreciate the response, however this does not address all of the issues.   The urinalysis was part of a wellness visit, not a diagnostic test, and should be covered 100%.   The pap smear was part of an annual well woman visit and should be covered 100%.   The Quest bills for ******************* were at an in-network provider and should be billed at the in-network rate.

    You can see many calls to Ameriben complaining about these charges- if that does not suffice as an appeal, let me know what does, as no other method was told to us other than there was nothing Ameriben could do.   Each time we called in, different Ameriben employees giving different answers to the same question- sometimes they said it should be covered 100%, sometimes they said something different.  They seem very confused about the Big Lots benefit plan and have stated as much.

    Another issue is that the phone # on the back of our insurance card for providers to verify benefits goes to Anthem, not Ameriben.  This has caused discrepancies in the amount of out of pocket/deductible charged to us.
  
  Sincerely,
  
  **************************

  Business Response

  Date: 01/19/2023

  Dear Resolution Specialist:
  

  Thank you for the opportunity to respond to the follow up complaint received from Ms. ********* In response to this inquiry AmeriBen would like to share the following information.
  AmeriBen reexamined the charges in question and the employer's plan document.  This additional review resulted in an adjustment to reprocess Ms. ********* charges under the 100% wellness benefit of the plan. A corrected explanation of benefits issued on January 11, 2023.  The claim under complaint for Mr. ******************* was also adjusted to process under the In-network benefit level, and a corrected explanation of benefits issued on January 11, 2023.

  
  The complaint regarding discrepancies with information provided by AmeriBens phone representatives, and out-of-pocket/deductible amounts, could be due to variety of reasons, such as human error or a system glitch. 

  
  At the time of the original claim determinations, Ms. ********* & ************** explanation of benefits provided specific information regarding written appeal options, however neither elected to submit a written request for appeal as defined in their plan document.

  
  AmeriBen strives to address members concerns and properly pay eligible claims. Please let me know if you require additional information from us. Again, we appreciate the opportunity to respond to the concerns raised.

  
  Sincerely,
  *****************************
  

  
  

• Initial Complaint

  Date:11/28/2022

  Type:Billing 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 6/7/22, I took my infant daughter to Central **** ************ for her normal vaccinations and checkup. A claim was filed with my insurance, Anthem. A third party processes claims for my insurance, called AmeriBen, while Anthem pays them. This was allegedly paid and no patient responsibility, per AmeriBen. Over the next 5 months I have received bills from the provider stating I owe $853.88 for this claim. I have called numerous times to both provider and AmerIBen, including multiple 3-way calls between the two where AmeriBen claims Anthem has paid this claim and the provider saying they are not receiving the payment. I was told to call Anthem, who actually pays the claims, myself, and was promptly transferred back to AmeriBen after an hour of trying to get through. This is ludicrous and nobody wants to resolve this situation, and I am the one sitting here with a bill about to go to collections that I am not responsible for. I have been left no recourse but to file this complaint because every time I call, all I get is "We will file this and get back to you" and nobody ever gets back to me.

  Business Response

  Date: 11/22/2022

  Dear ************:
  We have reviewed your complaint, dated November 9, 2022, filed on behalf of member
  *************************************. The complaint regards bills he is receiving for vaccinations and a
  checkup for his daughter.
  

  A review of this complaint indicates the members home plan is AmeriBen, administered
  in *****. In an effort to have the complaint reviewed, please forward the complaint to
  the members home plan at:
  

  AmeriBen
  2888 *******************
  ********, ** *****
  

  Thank you for bringing your concerns to our attention. If you have any questions or
  concerns, please call me directly at **************.

  Business Response

  Date: 12/20/2022

  Upon review of the claim from ******************************* MD of Central **** *************** was determined that a network system glitch prevented the expected original payment to issue. An adjustment was done on 12/14/22 and a new explanation of benefits and payment has been issued.   I have enclosed a copy of the members EOB for the current processing