Complaints
This profile includes complaints for The Rawlings Group's headquarters and its corporate-owned locations. To view all corporate locations, see
Customer Complaints Summary
- 40 total complaints in the last 3 years.
- 13 complaints closed in the last 12 months.
If you've experienced an issue
Submit a ComplaintThe 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:06/03/2025
Type: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 have contacted Rawlings numerous times in regards to sending over the final lien with the reduction to my attorney which has yet to be done so my file can be closed out they sent over a lien back in April but it was not final and the adjuster has not been responding to any emails or phones I requested the matter be escalated to someone higher and I was ignored. Claims are being reprocessed after requesting the needed documentation then what was sent over was higher than what my insurance actually paid to not have my concern addressed in a timely manner is unacceptable this has been going on for MAJOR Hardship due to this runaround with the adjuster assigned to my case I would like for some response to be made or for someone to let me know what is going on I'm going to lose everything just waiting on a company that continues to play the wait it out game.
Business Response
Date: 06/12/2025
June 11, 2025
***
***** ********* **** *****
*********** ** *****
RE: Complaint ID:
********
Ladies and Gentlemen:
This
letter is in response to the Complaint filed with your organization bearing
*********. For over forty years, Rawlings has provided claims recovery services
to health insurance companies and health plan administrators throughout the
country. Rawlings seeks to recover through subrogation or reimbursement
payments made by the plan for medical claims which should have been paid by
other parties, such as in the case of an accident caused by a third party.
Rawlings is contracted to provide these recovery services on behalf of the
Complainant's health plan. The health plan paid medical claims on behalf of the
Complainant that allegedly resulted, in whole or in part, from such an
accident.
The
Complainant is represented by legal counsel. For the past couple of months,
Rawlings has been working with her attorney regarding the amounts paid by the
health plan and the health plan’s legal recovery rights. On June 2, 2025,
Rawlings spoke to the attorney and advised it is waiting on claim denial
information from the health plan and once that information is received it will
provide a final itemization. This same
information was conveyed to the Complainant on 5/28/2025 and 6/10/2025. Rawlings is not aware of any emails received
from Complainant.
As the representative of the health
plan regarding its recovery rights, Rawlings will
continue
to work with the Complainant’s legal counsel to resolve the plan’s pending
recovery claim. We regret any
inconvenience or concern that this process may have caused the Complainant.Customer Answer
Date: 06/18/2025
Complaint: ********
I am rejecting this response because:
I have not been informed about anything that has been going on I’ve been directed to contact my attorney but if they were given the information requested I wouldn’t have had to call to find out anything myself and still there has not been any resolution to my claim this a long drawn out process that should’ve been simple but we are now into June and still nothing so my case can be settled.
Sincerely,
****** *********Business Response
Date: 06/19/2025
June 19, 2025
BBB
***** ********* **** *****
*********** ** *****
*** ********* *** ********
Ladies and Gentlemen:
This
letter is in response to the Complaint filed with your organization bearing
********* and Complainant’s apparent “rejection” of Rawlings’ response to same.
The
Complainant is represented by legal counsel.
On June 10, 2025, a Rawlings analyst spoke to Complainant and again advised
that it was waiting on claim denial information from the health plan and once
that information was received it would provide a final itemization to her
attorney. The Rawlings analyst explained
that when an individual is represented by legal counsel, Rawlings will work
with legal counsel to resolve the individual’s claim. This prevents claims by the individual’s
counsel that Rawlings somehow interfered with the attorney/client relationship. When a health plan member, such as
Complainant, is represented by legal counsel, it is both customary and expected
for Rawlings representatives to work with the health plan member’s attorney to
resolve the claim. Rawlings is
prohibited from dictating or influencing the relationship between Complainant
and her legal counsel.
On
June 17, 2025, Rawlings received the claim denial information it needed from
the health plan. After review of the
claim denial information, on June 18, 2025, Rawlings sent a final itemization
to Complainant’s attorney. As the
representative of the health plan regarding its recovery rights, Rawlings will
continue to work with the Complainant’s legal counsel to resolve the plan’s
pending recovery claim. We hope this
information is instructive and regret any inconvenience or concern that this
process may have caused the Complainant.Customer Answer
Date: 06/20/2025
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,
****** ************If you are interested in supporting the BBB's free services, please consider giving to BBB's Consumer Education Fund, which provides other services to the community, like Charity Review, Identity Theft Seminars, Free Shred/Recycle Events, Senior Citizen programs, High School and College Programs, and providing information at local community events. Donations can be sent via Venmo to @bbbcefky or mail your donation to BBB Consumer Education Fund, 13104 Eastpoint Park Blvd., Louisville, KY 40223. For more information on these programs, call 800-388-2222. Thank you for your consideration.Initial Complaint
Date:04/07/2025
Type: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 was in a car accident in December of 2022
-I received a settlement claim May 2024.
-Several months after settlement I began receiving calls from Rowlings Group
-Spoke with *** *****, was told my bill from the night of accident needed to be reimbursed. i was confused as I thought my lawyer had covered this.
-My lawyer **** *********** refused to speak with me or negotiate. I did not know where to go from there.
-I sent an email to *** October 24, 2024 asking to discuss payment plans
-I did not hear anything back.
-December 2024 my mother ***** ******* began noticing her retirement checks were $540 short.
-Until February 2025 my mother did not have any knowledge of why this was happening or where her money was going
-After several calls to insurance she was told by Blue Cross Blue Shield that the Rowlings company were garnishing her wages.
-I called the Rowlings company several times to attempt to move payments to my name or negotiate a payoff. Several different employees denied the pleas of both my mother and I and repeated that they will not stop until full lein is paid
-This is causing extreme stress to my retired mother and I, and I don’t think it’s right that they have garnished with no permission or even knowledge from my mother.Business Response
Date: 04/14/2025
This letter is in response to the Complaint
filed with your organization bearing #********. Rawlings seeks to recover payments made by health plans for medical claims which should have
been paid by other parties, such as in the case of an accident. Rawlings has been contracted to provide these recovery services on
behalf of the Complainant's health plan. The Complainant has coverage through this
plan for which her mother is the named subscriber. The plan’s reimbursement rights
are governed by North Carolina law and are further detailed in the Plan
Description provided to the subscriber .
The health plan paid on behalf of the
Complainant medical claims that allegedly resulted from an
accident. The Complainant was represented by legal
counsel and received a settlement from the at-fault party’s insurance carrier.
This settlement included the medial bills paid by Rawlings’ client which should be repaid to the health plan.
On several occasions, through mail and e-mail,
the Complainant was notified of the health plan’s right to reimbursement for
the claims it had paid and the potential consequence should the repayment not be addressed. An itemization of these claims was sent to the
Complainant. Additionally, Rawlings has spoken by telephone with the
Complainant and her mother regarding the amount to be reimbursed to the health
plan. Rawlings attempted to arrange with the Complainant a repayment plan. No
response was received.
Rawlings then notified the health plan of the unsuccessful
attempts to obtain repayment. The health plan referred this matter for wage
garnishment as permitted by North Carolina statute. The health plan advises
that since the adult Complainant is a dependent on her mother’s policy, it is
her mother who is responsible for the repayment. The Complainant and her mother
have been advised of this on numerous occasions. On April 4, 2025, Rawlings
provided to the Complainant the amount of the outstanding balance.Initial Complaint
Date:04/03/2025
Type: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 am being charged $574.21 by this company through BlinkRx for eyedrops that I did not order. They are sending me to collections when I cannot afford to pay this.Business Response
Date: 04/11/2025
This communication is in response to the Complaint filed with your organization bearing #********.
The Rawlings Group (“Rawlings”) provides data mining and claims recovery
services to health insurance companies and administrators, including the
Complainant’s former health insurer. As part of its work, Rawlings seeks to
recover payments which were made by its clients for prescriptions filled after an
individual’s coverage with that insurer or plan has ended.
The
records of the Complainant’s prior insurer reflect that a prescription was
filled after her coverage with that insurer ended. Rawlings’ client was
nonetheless billed by the pharmacy and paid for that prescription. Rawlings has
spoken to the Complainant on at least three occasions this month, most recently
on April 8, 2025. At that time, the Complainant advised that she was working
with the pharmacy to the correct the billing issue. Rawlings has informed the
Complainant that it will bill the correct health plan with respect to this
prescription. Rawlings is not sending, and has not sent, the Complainant to
collections.
We
trust that this will help to resolve the Complainant’s concerns. We certainly
regret any inconvenience that this process may have caused the Complainant.
Please do not hesitate to let us know if additional information is needed.
Thank you.Initial Complaint
Date:04/03/2025
Type: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.
This complaint is in regards to the Rawlings Company, who is allegedly contracted by Health Net of California. I recently received notification from a medical provider that a letter had been sent by The Rawlings Company on behalf of Health Net, claiming that I had health insurance through another insurance company and that The Rawlings Company required all payments issued by my provider to be refunded/returned. This claim by The Rawlings Company was not only completely untrue, but also it was the first time I had even heard of an issue. A week later, I received notification from a second medical provider in receipt of a similar letter from the Rawlings Company. At that point, I contacted Health Net to attempt to verify the claims of The Rawlings Company. Health Net informed me and confirmed that there were NO disputes or issues with ANY of my claims and that they had recently confirmed that I had no additional insurance coverage. I have heard from a medical provider that The Rawlings Company has reached out yet again, demanding repayment. At this point, The Rawlings Company conduct is bordering on harassment and extortion. They need to be held accountable and others warned. Both my own health plan with Health Net and myself have also have tried to contact the individual who is in charge of my investigation file via phone and email, and we have not heard back. It is ridiculous that Health Net themselves are saying there is no problem with my claims, yet this random Rawlings Company starts an investigation on my file harassing not only myself with letters, but also all my providers. This unnecessary investigation must stop.Business Response
Date: 04/11/2025
This
communication is in response to the Complaint filed with your organization
bearing #********. The Rawlings Company, LLC (“Rawlings”) provides data mining
and claims recovery services to health insurance companies and administrators. As
part of its work, Rawlings seeks to recover payments made to medical providers
by one insurer which should have been paid by a different health plan. The
issue is which health plan is the proper carrier to pay relevant claims.
In this instance, the Complainant is
covered as a dependent under two different medical plans. Rawlings’ client paid
claims billed to it by medical providers. Subsequent to these payments,
Rawlings’ investigation revealed that the Complainant had current coverage
through a health plan other than Rawlings’ client. This other carrier should be
the primary payor of the medical claims involved because it has been in effect
longer.On at least two occasions, Rawlings
has confirmed with the Complainant that his parent is still actively employed
by 2 different employers and enrolled in their respective health plans.Rawlings has not requested the
payment of any money from Complaint. We understand that the Complainant did
pay a claim for one facility. Rawlings is not seeking any payment regarding
this claim.We also understand that there are
other providers which were paid by Rawlings’ client. Rawlings is attempting to
recoup its client’s payment of these claims from the primary carrier who should
then adjudicate and pay on those claims according to its policy.We appreciate the fact that this
process can be complicated and time-consuming. We certainly regret any
inconvenience that this process may have caused the Complainant. Should the Complainant
have any additional questions related to this matter, he should contact ****, Payment Integrity- Senior Manager at ************.Customer Answer
Date: 04/11/2025
Complaint: ********
I am rejecting this response because:I did confirm with Rawlings that my parent is still actively employed by 2 different employers. But I never confirmed that my parent is enrolled in their respective health plans.
I am paying all my claims out-of-pocket for three facilities on an ongoing basis. I have paid claims out-of-pocket for a few other facilities as well.
Rawlings fails to address why they are harassing me and all my providers with multiple demand letters, despite my providers not being able to issue any sort of refunds since Rawlings’ client is my primary payor and always has been for the past few years. I do not have knowledge of, nor have I ever used, another health plan for which my parent is enrolled in. I have also confirmed this with my parent. In fact, I have even confirmed all of the above statements of fact with Rawlings’ client on multiple occasions. Rawlings’ client has informed me that they find no issue with any of my claims and also show in their system that Rawlings’ client is my primary payor. Therefore, I demand that Rawlings cease their unnecessary investigation on me as well as harassing me and my providers.
Sincerely,
**** *******Business Response
Date: 04/16/2025
Rawlings has re-confirmed its finding that the Complainant
is covered by two health plans for the relevant date(s) of service. Under the
applicable coordination of benefits rules, the coverage of Rawlings’ client is secondary
to that of the other carrier. (Rawlings does not directly update its client system
to indicate such findings.)Rawlings is not harassing the Complainant nor the providers.
Rather, Rawlings is engaging in a common process to identify and coordinate
benefits when another carrier is primary. Rawlings will work with the primary
carrier to adjudicate the claims in question.Customer Answer
Date: 04/17/2025
Complaint: ********
I am rejecting this response because: I confirmed with the supervisor of the Payment Integrity Analyst who is assigned to investigate my case that my case had been written off on April 2nd, 2025. Also, the Rawlings Company was in fact harassing me and my providers; I confirmed with my providers that they continued to receive 3-4 letters in the mail in the last week of March 2025, such as "COB Second Requests," asking them to provide refunds. I have re-confirmed with both my parent and my health plan with Health Net of California that I am only covered by Health Net as my primary insurance. No one from Rawlings has ever contacted me by phone or email regarding why this investigation was started and why my providers are being harassed. The only solution I am now requesting, based on Rawlings' response, is that they halt efforts to "work with the primary carrier to adjudicate the claims in question," and confirm that my case has now been written off effective April 2, 2025.
Sincerely,
**** *******Business Response
Date: 04/28/2025
As noted before, Rawlings has confirmed that the Complainant has coverage through 2 health plans for the relevant dates of service. The coverage through Rawlings client is secondary. In order to bring this matter to a close and as an accommodation to the Complainant, however, Rawlings will close its remaining open claims and cease its recovery efforts related to those.Customer Answer
Date: 04/29/2025
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,
**** **********If you are interested in supporting the BBB's free services, please consider giving to BBB's Consumer Education Fund, which provides other services to the community, like Charity Review, Identity Theft Seminars, Free Shred/Recycle Events, Senior Citizen programs, High School and College Programs, and providing information at local community events. Donations can be sent via Venmo to @bbbcefky or mail your donation to BBB Consumer Education Fund, 13104 Eastpoint Park Blvd., Louisville, KY 40223. For more information on these programs, call 800-388-2222. Thank you for your consideration.Initial Complaint
Date:03/19/2025
Type: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.
The Rawlings Company LLC identified that I had another insurance and is working for Cigna (my current health insurance carrier) to coordinate benefits with the "second" insurance carrier.
There was an overlap of coverage when I changed jobs, which led to a change in carriers. I had United Health Care coverage from 10/1/2023. That coverage ended on 8/31/2024. Cigna coverage stared on 8/1/2024. Consequently, there was a one month overlap that I was not aware of.
Rawlings sent notice to Cigna that I had a second insurance and that the second insurance should be my primary insurance. Based on this notice, Cigna began denying my claims.
I contacted Rawlings about this issue after correcting the dates with Cigna the first time and finding that the dates were again changed to remove the end date of the other coverage.
I contacted Rawlings again when additional claims were denied by Cigna due to having another insurance. I was told that they had received confirmation that the dates of my coverage had been corrected with Cigna and that they had received verification from Cigna of the correction. I was told that claim was submitted prior to Rawlings correcting the date with Cigna, and they would escalate the matter again so that the claim would be paid. They told me it would be another three to five days.
I told Rawlings at that time that my doctor was in the middle of seeking prior authorization for an upcoming surgery and if the end date was not fixed with Cigna, it could delay or prevent my upcoming surgery. However, their response was simply to say they would escalate the matter and that it could take up to 5 days to fix it.
At this point, I contact Cigna again and after three hours, correct the dates again. Cigna indicated they had not received any communication from Rawlings on the matter. Rawlings is still conducting their "investigation" and has failed to provide any assurances that they will not cause the same problem again.Business Response
Date: 03/28/2025
This communication is in response to the Complaint filed with your organization bearing #********.
The Rawlings Company, LLC (“Rawlings”) provides data mining and claims recovery
services to health insurance companies and administrators. As part of its work,
Rawlings seeks to recover payments made to medical providers by one insurer which
should have been paid by a different health plan. The issue is which health
plan is the proper carrier to pay relevant claims.
In this instance, Rawlings
identified that the Complainant’s medical provider was paid by Rawlings’
client. Rawlings’ investigation also revealed that the Complainant had other coverage
through another health plan which should have been the primary payor of the
medical claims involved. This information was reported to Rawlings’ client. It
is our understanding, however, that there
was an issue experienced when updating the termination date of the other
coverage. Upon discovery of this issue, Rawlings’ client was notified and its
records corrected.
A Rawlings representative
spoke with the Complainant on March 19, 2025 and discussed how the information had been updated. We
provided feedback on the steps needed to have any denied claims reprocessed.
We certainly recognize
the frustrations and inconvenience that this matter caused the Complainant. We encourage her to continue to reach out to Rawlings or our client directly should she need additional
assistance. We have provided her with the contact information of one of Rawlings’
supervisors to expedite any communication on further questions she may have regarding
this matter.Initial Complaint
Date:03/17/2025
Type: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.
Company did not allow negotiations on a over $1,000 took full it and would not allow me to negotiate I had a lawyer that told me she was negotiating to lower the lien on my behalf I have been out of work for over a year due to my injuries and had severe hardships I was diagnosed with major depressive disorder and anxiety I have been having an extremely hard time reach this company I have called multiple times for months they do not answer and they do not return calls I do think it was fair for them to take the full lien amount without trying to resolve it .Business Response
Date: 03/27/2025
This communication is in response to Complaint # ******** received on 3/17/25. Rawlings seeks to recover through subrogation and/or reimbursement payments made by the health plan for medical claims which should have been paid by other parties, such as in the case of an accident caused by a third party. Rawlings is contracted to provide these recovery services on behalf of the Complainant's health plan. The health plan paid on behalf of the Complainant medical claims that allegedly resulted, in whole or in part, from such an accident.
It is our understanding that the Complainant was involved in an accident while a passenger in a motor vehicle in March 2023. At some point, he was represented by legal counsel. Pursuant to applicable law and the language in the Complainant’s health plan, the plan has its own separate legal right to recover the monies it paid on behalf of the Complainant from the at-fault party and appropriate property and casualty (auto) insurance carriers.
Throughout 2023 and the first part of 2024, Rawlings communicated with the auto insurance carrier and the Complainant’s attorney. In pursuit of its claim, itemizations of the amounts paid by the health plan were provided to these parties, as well as to the Complainant. Our records reflect that on at least 3 occasions in early 2024, Rawlings communicated with the Complainant about the health plan’s claim. In 2024, the auto carrier settled and resolved with Rawlings the health plan’s legal claim, and Rawlings closed its file. The Complainant was advised of this in 2024
The health plan’s claim and settlement was appropriate pursuant to applicable law and the language of the health plan. The plan’s claim against the carrier has been satisfied, and no amount is due or owing from the Complainant with respect to his March 2023 accident. Likewise, no amount is owed by the health plan to the Complainant with respect to the plan’s settlement with the auto carrier.
Customer Answer
Date: 03/27/2025
Complaint: ********
I am rejecting this response because: due to poor legal representation and the insurance company for the company and rawlings I was left out.of negotiate to have this bills lowered as I have the option to negotiate on my own behave or the attorney can negotiate to have the medical lien neither happen the rawling company did not contact me directly or notifications me that I had a medical lien I was forced to accept a small settlement because the lawyer was not working or negotiating on my behalf like she said she was they me offered under $5k then money was removed and paid to rawlings company when I contacted rawlings I for a copy of the invoice showing what was paid multiple accidents that was not related to the accident in question was listed on the bill I never injured my ankle in a car accident . I will look into filing complaints with the attorney General fcc and any other agencies that may take complaint for this issue I was robbed by rawlings company and let out of negotiations the attorney and statefarm didn't inform me about who had possession of the medical lien I am going to continue to file complaints because this was unfair and possibly illegal
Sincerely,
***** *****Business Response
Date: 04/02/2025
Rawlings disputes the Complainant's allegations against it of unfairness and illegality. However, an authorized representative of Rawlings will contact the Complainant on or by April 8, 20005 to discuss possible resolution of this matter.Customer Answer
Date: 04/03/2025
Complaint: ********
I am rejecting this response because: I talked to a supervisor name ******* ********* she said she would assign the case to herself to work with me to resolve the issue I have emailed her abd called her but she has not replied she did say she was going to be out of the office until middle of this week I am awaiting her call
Sincerely,
***** *****Business Response
Date: 04/11/2025
This communication is in response to the
most recent message from the Complainant dated 4/8/25.
Since our initial response to
the Complaint on April 2, 2025, an Operations Manager (*****) spoke and/or left
messages with the Complainant on three occasions. (***** will be working with
the Complainant going forward.) On 4/3/25, ***** and the Complainant discussed
the matter and a resolution. It was agreed that Rawlings would send to a check
to the Complainant for an agreed upon amount. On 4/4/25, ***** left a message
stating that the check was on its way. A message to this effect was again left
with the Complainant on 4/7/25. A release has also been e-mailed to the
Complainant for signature and return.Initial Complaint
Date:03/11/2025
Type: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.
The Rawlings Group is subrogating on behalf of my Medical Insurance and trying to charge an incorrect amount. They are overcharging by almost $1300 off of the ALLOWED amount from ***** however ***** does not pay 100% of the allowed amount per my insurance plan, they only pay a %. Because they are overcharging this is holding up my Settlement and I've had to contact my insurance company who has also reached out to Rawlings and let them know that they cannot charge me the "allowed" amount but only the amount that ***** actually paid. I paid all of my Copays and Coinsurances, Rawlings is essentially trying to make me pay those amounts again, which is "robbery." I would like for the BBB to help me get this matter resolved. I tried to upload each EOB but the file was too big, I can supply proof of my issue and payments from my insurance company.Business Response
Date: 03/21/2025
Ladies
and Gentlemen:
This
communication is in response to the Complaint filed with your organization
bearing # ********. For over forty years, Rawlings has provided claims recovery
services to health insurance companies and health plan administrators
throughout the country. Rawlings seeks to recover through subrogation and/or
reimbursement payments made by the health plan for medical claims which should
have been paid by other parties, such as in the case of an accident caused by a
third party. Rawlings is contracted to provide these recovery services on
behalf of the Complainant's health plan. The health plan paid on behalf of the patient
medical claims that allegedly resulted, in whole or in part, from such an
accident.
The patient is represented by legal
counsel. As such, Rawlings has exchanged communications with the patient’s
attorney regarding the amounts paid by the health plan and potential recovery.
Indeed, on March 14, 2025, a Rawlings representative spoke by telephone with both
the attorney and the Complainant on a conference call. Rawlings has advised
counsel of the amount paid by the health plan. The Complainant states that
Rawlings is “trying to charge an incorrect amount.” Rawlings disputes this
conclusion.
After the provider bills the health
plan for services, a discount is applied by the health plan to determine the
total owed to the provider. The health plan then pays its share, which in this
case is 85% of the amount to be paid to
the provider. The remainder is the insured’s share. The amount sought by Rawlings is the amount
actually paid to the provider by the health plan. Amounts paid in the form of
copays or coinsurance are not being sought.
Rawlings will continue to work with
the Complainant’s legal counsel to resolve the
pending claim of the health plan. We regret any inconvenience or concern
that this process may
have caused the
Complainant.Customer Answer
Date: 03/21/2025
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,
****** ********If you are interested in supporting the BBB's free services, please consider giving to BBB's Consumer Education Fund, which provides other services to the community, like Charity Review, Identity Theft Seminars, Free Shred/Recycle Events, Senior Citizen programs, High School and College Programs, and providing information at local community events. Donations can be sent via Venmo to @bbbcefky or mail your donation to BBB Consumer Education Fund, 13104 Eastpoint Park Blvd., Louisville, KY 40223. For more information on these programs, call 800-388-2222. Thank you for your consideration.Initial Complaint
Date:02/24/2025
Type: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.
see Attached documentBusiness Response
Date: 03/05/2025
Ladies and Gentlemen:
This letter
is in response to the Complaint filed with your organization bearing #********.
The Rawlings Group (“Rawlings”) provides data mining and claims recovery
services to health insurance companies and administrators, including the
Complainant’s health insurer. As part of its work, Rawlings seeks to recover
payments which were made by its clients for prescriptions filled by a pharmacy after
an individual’s coverage with that insurer or plan has ended.
In
this instance, Rawlings’ client paid claims on behalf of the Complainant for
prescriptions. Based upon the information available to it, Rawlings sent a
letter to the Complainant advising that prescriptions were paid by her insurer
after she was no longer eligible for coverage. After sending this letter, but
before receiving this Compliant, Rawlings learned that the employer of
Complainant’s husband had incorrectly canceled her coverage.
We
understand that the coverage has now been reinstated. On or about 2/18/25, Rawlings
sent a letter to the Complainant advising that its file has been closed, and no
payment is being sought.
We
trust that this will help to resolve the Complainant’s concerns. We certainly
regret any inconvenience that this process may have caused the Complainant.
Please do not hesitate to let us know if additional information is needed.
Thank you.Initial Complaint
Date:12/23/2024
Type: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.
Ref #********* The Rawlings Group acting on behalf of **** ****** was trying to recover money **** ****** paid to medical bills related to an accident. I reached out to the Rawling Group on 11/25/24 when I was made aware from a 3rd party car insurance company that there was a lien against ********* *******. I spoke to **** ****** and he went over the bills on the lien. Some bills were unrelated to the car accident and he had to remove. There were several bill that were paid my car insurance directly to the providers. I sent him the pay logs and bills paid my car insurance ***** **** and he said he would check for overpayment with the providers. I asked for an updated lien via email and he refused and said he sent it to the insurance company and take it up with them. I reach out to his supervisor ******* **** on 12/4/24 and she said **** was still in training and she was still teaching him she sent the updated leon but there was still the bills that my insurance paid to the providers. 12/5 I was sent an updated lien of $246.88. I contacted ***** **** to process payment for this lien and they sent a check to Rawlings Group 12/6. **** called me 12/20 saying the received the check from ***** **** and I requested a letter saying the lien had been closed. He said the lien wasn’t closed because they were still waiting for the overpayment from the medical provider. He said he would have reach out to Heather. I contacted ******* this same day via phone to try to understand why I was sent an updated lien 12/5 and then the lien was paid in full and now this lien is still not closed according to them.
I attach the original lien as of November 25 and the updated lien as of December 5 as well as the email communication between me, ******* and ****. As well as the pay logs from my car insurance company, State Farm, where they paid the medical providers directly.Business Response
Date: 12/31/2024
Rawlings acknowledges receipt of this Complaint. Due to holidays schedules, and desiring to make a complete investigation of the Complainant's concerns, Rawlings requests additional time to respond thru and including Jan. 8, 2025.
Thank you.
Initial Complaint
Date:12/11/2024
Type: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.
This complaint is in regards to the Rawlings Company, who is allegedly contracted by ***** **********. I received notification from a medical provider in late October 2024 that a letter had been sent by The Rawlings Company on behalf of *****, claiming that I had health insurance through another insurance company and that The Rawlings Company required all payments issued by ***** to be refunded/returned. This claim by The Rawlings Company was not only completely untrue, but it was the first time I had even heard of a potential issue. A week later I received notification from a second medical provider in receipt of a similar letter from the Rawlings Company. At that point I contacted my insurance provider to attempt to verify the claims of The Rawlings Company. My insurance provider informed me that there was NO disputes or issues with my claims and that they had recently confirmed that I had no additional insurance coverage.
On 21 November I sent an email to all the representatives of The Rawlings Company that had contacted medical providers of which I was a client. In my email, I informed The Rawlings Company that I had been unable to verify their claims with either my insurance company, nor the insurance company they claimed I had a second plan with. I provided all necessary details and requested that they terminate any future attempts to collect unwarranted compensation.
On 25 November, I received a response to my email from a "Payment integrity analyst" at The Rawlings Company. They repeated their claims but provided no evidence to support it. I responded the same day with additional information proving their claims inaccurate and have heard no response as of today, 10 December 2024, more than 2 weeks later. However, I have heard from a medical provider that The Rawlings Company has reached out yet again, demanding repayment. At this point, The Rawlings Company conduct is bordering on harassment and extortion. They need to be held accountable and others warned.Business Response
Date: 12/20/2024
Ladies and Gentlemen:
This communication is in response to
the Complaint filed with your organization bearing #********. The Rawlings
Company, LLC (“Rawlings”) provides data mining and claims recovery services to
health insurance companies and administrators. As part of its work, Rawlings
seeks to recover payments made to medical providers by one insurer which should
have been paid by a different health plan. The issue is which health plan is
the proper carrier to pay relevant claims.
In this instance, the Complainant’s
medical provider was paid by Rawlings’ client. Subsequent to this payment,
Rawlings’ investigation revealed that the Complainant had current coverage
through another health plan (the primary carrier) which should be the primary
payor of the medical claims involved. Rawlings reached out to the Complainant’s
medical providers: to advise them that the primary carrier, as opposed to
Rawlings’ client, should be billed for their services; and to refund the
amounts paid by Rawlings’ client once they are paid by the primary
carrier.Rawlings has been contacted by the
Complainant who advised that he has no current health coverage other than that
provided by Rawlings’ client. Rawlings has re-verified with the primary payor
that the Complainant does in fact have coverage through the primary carrier for
the relevant claims. We encourage the Complainant to verify with his employer
the status of his coverage.Rawlings
has closed its file with respect to its
recovery of the claims paid by its client. We appreciate the fact that this
process can be complicated and time-consuming. We certainly regret any
inconvenience that this process may have caused the Complainant.
Please do not hesitate to let us
know if additional information is needed.
Customer Answer
Date: 12/23/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that while they have “resolved” the complaint by closing collection efforts, there are no acknowledgments or attempts to address their conduct. The complaint has been resolved and I accept their response. However, I hope the Rawlings Group considers evaluating their procedures with regards to how they conduct their business.
Sincerely,
****** S.***If you are interested in supporting the BBB's free services, please consider giving to BBB's Consumer Education Fund, which provides other services to the community, like Charity Review, Identity Theft Seminars, Free Shred/Recycle Events, Senior Citizen programs, High School and College Programs, and providing information at local community events. Donations can be sent via Venmo to @bbbcefky or mail your donation to BBB Consumer Education Fund, 13104 Eastpoint Park Blvd., Louisville, KY 40223. For more information on these programs, call 800-388-2222. Thank you for your consideration.
BBB Business Profiles may not be reproduced for sales or promotional purposes.
BBB Business Profiles are provided solely to assist you in exercising your own best judgment. BBB asks third parties who publish complaints, reviews and/or responses on this website to affirm that the information provided is accurate. However, BBB does not verify the accuracy of information provided by third parties, and does not guarantee the accuracy of any information in Business Profiles.
When considering complaint information, please take into account the company's size and volume of transactions, and understand that the nature of complaints and a firm's responses to them are often more important than the number of complaints.
BBB Business Profiles generally cover a three-year reporting period, except for customer reviews. Customer reviews posted prior to July 5, 2024, will no longer be published when they reach three years from their submission date. Customer reviews posted on/after July 5, 2024, will be published indefinitely unless otherwise voluntarily retracted by the user who submitted the content, or BBB no longer believes the review is authentic. BBB Business Profiles are subject to change at any time. If you choose to do business with this company, please let them know that you checked their record with BBB.
As a matter of policy, BBB does not endorse any product, service or business. Businesses are under no obligation to seek BBB accreditation, and some businesses are not accredited because they have not sought BBB accreditation. BBB charges a fee for BBB Accreditation. This fee supports BBB's efforts to fulfill its mission of advancing marketplace trust.