Complaints

This profile includes complaints for Harvard Pilgrim Healthcare, Inc.'s headquarters and its corporate-owned locations. To view all corporate locations, see Find Local Branches.

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• 

  Harvard Pilgrim Healthcare, Inc.

  1 Wellness Way Canton, MA 02021-1166

• 

  Harvard Pilgrim Healthcare, Inc.

  1600 Crown Colony Dr Quincy, MA 02169-0913

• 

  Harvard Pilgrim Healthcare, Inc.

  401 Park Dr Ste 401 Boston, MA 02215-3369

• 

  Harvard Pilgrim Healthcare, Inc.

  55 Capital Blvd Rocky Hill, CT 06067-3927

• 

  Harvard Pilgrim HealthCare of New England

  160 South River road, Suite 201 Bedford, NH 03110

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:05/16/2025

  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.

  I use GENERIC lispro insulin for my type 1 Diabetes. Harvard Pilgrim charged me a tier 3 copay ($50) and the **************** *** said that ****** is a Brand name when I know it is not! No discount for mail order. They are charging a tier 3 copay for generic medicines! I could get the brand name for same copay under this plan! This health plan is a joke! Something has to change!

  Business Response

  Date: 05/19/2025

  Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime.  Thank you.

• Initial Complaint

  Date:05/07/2025

  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 called ** in December 2024 after reaching my deductible. I informed them that I had a bone density test scheduled in January 2025, and asked if it would be better to move the appointment to December since I had already met my deductible and was trying to avoid any out-of-pocket expenses. I was told that moving my appointment was not necessary because a bone density test falls under an "Act" (cannot recall the name), so there would be no out-of-pocket cost regardless of when I had the appointment. I kept my appointment for January, only to receive a $500+ bill after the appointment. I called **, and they informed me that my provider coded the appointment incorrectly, that they would resubmit the claim, and to disregard the bill. They had an audio recording of my conversation the previous month, assuring me of no out-of-pocket cost. A few weeks later, my provider called to tell me that I owed $500+. I called **, and they said they were trying to reach my provider and to disregard the bill. A few weeks later, my provider called me again to tell me that I owed $500+. I called **, and they said they were still trying to reach my provider and to disregard the bill. Tonight, I get another call from my provider regarding the $500 bill. They said that ** will need to call them regarding this, as they show the balance as my responsibility. I want ** to take immediate action to rectify this situation. They have the phone calls from the agents and supervisors that I spoke with, telling me that there would be no out-of-pocket costs, and now they are billing me, such a deceptive practice. They can reach me at my phone number on file, and I will gladly do a three-way call with them and my provider.

  Business Response

  Date: 05/08/2025

  Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime.  Thank you.

  Business Response

  Date: 06/04/2025

  See attached response 

  Customer Answer

  Date: 06/04/2025

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
  
  Regards,
  
  **** *********

• Initial Complaint

  Date:05/01/2025

  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.

  Our child has seen the same out-of-network therapist for 7 years, a benefit covered by our insurance, Harvard Pilgrim. We pay for each session, submit a claim, and are reimbursed part of the amount.Last Fall, our claims for reimbursement started being denied. We found out that Harvard Pilgrim had suddenly started categorizing the provider as "In network." She isn't. She never has been. We explained this to over half a dozen *************** ***resentatives and, after several months, they manually approved the claims and said it wouldn't happen ******** ******* they are denying all claims for reimbursement, insisting that the provider is in-network. The *************** ***resentative who had been able to manually approve the claims before said she is now prohibited from doing so by her supervisors.I have spoken with ***resentatives and supervisors and emailed pages of documentation. The provider has given written and verbal statements to Harvard Pilgrim clarifying that she is not now nor has she ever been in-network. They still won't pay the claims.April 4th I received 25 letters from Harvard PIlgrim, all denying our claims (which, again, is a covered benefit of our plan), signed by "******* *******, Director of Member and ******************* I called and asked to be connected with him and left a voicemail message about the ************ ***ly.Three weeks ago I was told that the matter had been "escalated to Behavioral Health" and that they would "reach out to the provider." This did not happen. When I tried to call ******* ******* again, the customer service *** told me "I am not allowed to connect you to that person."Apparently the Director of Member and ******** Services values gatekeeping his voicemail more than members receiving their *******'s been eight months of this. They owe us thousands of dollars. We have had to suspend our son's therapy because we can't continue to pay out of pocket for a benefit they are supposed to cover.

  Business Response

  Date: 05/02/2025

  Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file.Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime.  Thank you.
  
  
  

  Customer Answer

  Date: 05/02/2025

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********.

  Respectfully, Harvard Pilgrim has been giving us the "30 Days" response periodically since last October.  If they had resolved the issue, we would not be reaching out to the Better Business Bureau eight months later. 

  The provider was told by ***************** in February that they would correct her listing in the system in 30 days.  They didn't.  A *************** representative told us in the beginning of April that they had alerted ***************** and that "they have 30 days."  Nothing happened.

  The "30 Days" stock answer seems to be consistent with the "Delay, Deny, Depose" tactic used by the health insurance industry to wear people down so that they eventually give up on trying to recover the reimbursements they're legitimately owed.  It's shameful and, until last Fall, something we never would have expected from Harvard Pilgrim, whose service had been exemplary up until then.

  So no, another 30 days isn't going to cut it.  Someone at Harvard Pilgrim has the power to cut a check and correct the provider's status and they don't need 30 days to do it.  They can authorize this and have it done in an afternoon.  And that's what needs to happen.
  

  Regards,

  ********

   

   

• Initial Complaint

  Date:04/14/2025

  Type:Order 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.

  Harvard Pilgrim made an initial computer error and denied payment of my services, stating that I was not a provider of behavioral health services for them. I have been a provider for well over a decade. They realized this was an error, but it took several months to update the computer. When I didn't receive payment, I filed again. This time they denied payment for "untimely filing." I sent proof of timely filing, but they said it was not "acceptable" proof. The proof was exactly what they asked for online, the form was filled out correctly. They have not paid what they owe, and when I've called, no one can answer why except to repeat what was said about "acceptable" proof needed. This has gone nowhere. There is a current problem with this company, which I have contracted with as a therapy provider for a long time. They need to be accountable to the providers who offer valuable mental health services to their members.

  Business Response

  Date: 04/14/2025

  Your complaint has been received. Harvard Pilgrims *************************** team will investigate and outreach to you to discuss the issue. Thank you for bringing this matter to our attention.Please contact Harvard Pilgrims **************************** at ************ if you need assistance in the meantime. Thank you.

  Customer Answer

  Date: 04/22/2025

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
  
  Regards,
  
  ******** *******, Licsw

• Initial Complaint

  Date:02/18/2025

  Type:Delivery 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.

  Harvard Pilgrim Healthcare refuses to issue a 1099-HC form for my dependent who lives in ************* for which i have a judge's order to provide health insurance

  Business Response

  Date: 02/18/2025

  Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime.  Thank you.

  Customer Answer

  Date: 02/24/2025

  [A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
  
  Better Business Bureau:
  
  I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #********. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
  
  Regards,
  
  ***** ******

• Initial Complaint

  Date:01/07/2025

  Type:Service or Repair Issues
  Status:

  UnresolvedMore 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.

  Hello, My name is ******* ********* and I am a licensed mental health provider offering online/in-person therapy services to clients with the insurance, Harvard Pilgrim Health Plan. In 2021, I was approved as a provider for **** but under a private business' TIN. In February 2024, I applied to have my own private practice approved under a new TIN number and address. As of today, **** has not corrected my address or put in my appropriate TIN. I have made several calls and I keep getting the same response of, "give us 3 to 5 business days to correct your information". I have a client that is not receiving the mental health services that she needs because of this barrier. I have spoken to numerous staff members and supervisors to no success. I am very disappointed in the lack of timeliness in ****'s response especially when it comes to the care and services provided to their own clients. If you can help me address this matter, it would be greatly appreciated.

  Business Response

  Date: 01/08/2025

  Your complaint has been received. Harvard Pilgrims *************************** team will investigate and outreach to you to discuss the issue. Thank you for bringing this matter to our attention.Please contact Harvard Pilgrims **************************** at ************ if you need assistance in the meantime. Thank you.
  
  
  

  Customer Answer

  Date: 01/08/2025

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********.

   

  Thank you for the quick response, however, this is the exact ***** telephone number that I have called several times to have this addressed. I am always told that they are going to investigate and that someone will get back to me and no one has called me yet. This is a typical response from the agency and no follow up has ever been done. As much as I would love to accept this answer, I have heard it before with no success in follow-through

   

• Initial Complaint

  Date:11/22/2024

  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.

  Our son turned 26 and got his own insurance. I filled out a change form retroactive to October 20, 2023 and sent in proof of insurance for him on 11/30/23. They said they would update my account. April 2024, I called in as they had not made any changes and my son turned 26, they insisted they would and that they "missed" the form and they would update and process a credit. The change was then made, but they had billed me (and I paid it to not lose coverage) the higher rate as if my son was still on our plan and not corrected the amount. **************** stated that the credit would be done within 2 weeks and that I had to call back after to request the credit be actually sent to me, which sounded odd. I called back In reaching back out to ******* ****, he requested I email the form again and I again requested the credit be put through. I called back on May 29th and resent the forms to ******* **** as requested by the customer service *** to process the credit they said had not been processed. I then called back June 28th, after sending an email on June 26th, and left ******* a voicemail as I had done in May. I called in August 2nd and left a voicemail and also sent a follow up email on August 19th, with no response as I had done in May and June. I called again September 6th and left a message for ***** *****. I have now spoken to 2 managers whom I was told are the only ones who can help, ***** ***** and ******* **** and they refuse to call or email me back to resolve this, nor have I received a response. I have also called in many times to customer service and they assured me they would call me back after sending me to their voicemails, I am told they are on lunch or in a meeting every time. I am due $2,121.38 for the overcharge from 11/1/23 through 7/1/24. I have also attached the email chain with ******* ****.

  Business Response

  Date: 11/26/2024

  Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime.  Thank you.

  Customer Answer

  Date: 11/26/2024

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered. 

  I feel that accepting this would be very unhelpful to receiving a reslution as this has been going on for a very long time.  I have reached out to multiple "managers" and have yet to receive a response to both voicemails and many emails, so I don't trust this proposed process.  A written answer in 30 days in totally unacceptable, there was a mishandling on my account which caused me to overpay a lot of money with not a single call or replay back after many months of being ignored.  I have a family to support and I don't have faith that this will be handled properly, nor correctly via a written response.  The credit process, as explained to me by multiple customer service representatives, should be a manager approves the credit for being overcharged, they approve my credit to be sent to me and the process is complete.  I believe that my situation can easily be confirmed, credit processed and a call or notice that the credit is being sent to me is an acceptable outcome and I believe I deserve this to be expedited.
  
  Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
  
  FAQ
  
  Regards,

  Shiva

   

   

  Business Response

  Date: 12/03/2024

  Grievances do not qualify for expedited status. This rule applies to all members. For further discussion regarding your complaint, please contact Harvard Pilgrims ************************** at ************. 

• Initial Complaint

  Date:10/09/2024

  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 son had dental surgery in August 2024. We were told what was covered and what was not. We paid our half and now the insurance 2 months later is saying they wont pay what they said they would pay for so now we are left with a giant unexpected and unexplained bill.

  Business Response

  Date: 10/09/2024

  Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime.  Thank you.

• Initial Complaint

  Date:09/30/2024

  Type:Sales and Advertising 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 May 2024, I called Harvard Pilgrim requesting information regarding information about IVF coverage and Harvard Pilgrim's policies. It took multiple phone calls and over 4 weeks for Harvard Pilgrim to provide me with superficial information (yes, they covered up to 6 rounds of *** and yes my provider was included in this coverage). At no point did they share that insurance (**) would not provide coverage when using my eggs past the age of 45 (I was 44 1/4 when I pursued IVF). When seeking information, Harvard Pilgrim was a nightmare with communication. They continued to place roadblock after roadblock with my eligible timeline for coverage dwindling away. It took 4 weeks for Harvard Pilgrim to confirm whether or not my partner's frozen sperm would be covered by insurance, despite his having had chemo and radiation and his oncology team recommending use of his frozen sperm (from before treatment). I informed ** that my partner had previously had bladder cancer, with radiation and chemotherapy therapies provided. ** initially stated that my partner's frozen sperm (prior to chemo and radiation treatment) would be covered. In the ensuing months, ** required that my partner undergo sperm analysis (which showed ZERO sperm), asked that I complete the ****** challenge (which my numbers passed easily), and then when I should have been cleared to begin IVF treatments to use my own eggs, I was informed that AGAIN ** asked for last minute documentation, which meant that I could not pursue IVF treatment this month.....again HP pushed my treatment options out another month....with the months dwindling for which they will cover use of my eggs. This is UNETHICAL, AGEISM, and beyond RIDICULOUS! ** is preying upon their consumers in hopes that their time runs out and they will no longer be eligible for coverage. Please help me rectify this situation ****.

  Business Response

  Date: 10/02/2024

  Your
  complaint has been received. Harvard Pilgrim will investigate and provide a
  response with the findings directly to you in writing within 30 days at the
  address on file. Thank you for bringing this matter to our attention. Please
  contact Harvard Pilgrim’s Member Service Department at 888-888-4742 if you need
  assistance in the meantime.  Thank you.

• Initial Complaint

  Date:08/24/2024

  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.

  This is in regards to the recent denial claim under my daughters health insurance for July 1, 2024. I have been in touch with the manager, however I also would like for the higher ops to be involved. There have been recent changes to the healthcare providers. I never received any letter stating of the in network changes. After reviewing the letter when I received it from the customer service manager via email, whom I also recently spoke with those letters would still not have alarmed me to contact your customer service department to inquire about. The reason being is because the letter that was sent to me which I never received was not as vague as it should be just like auto PCP select. Nowhere in the letter that was supposedly mailed to me showed their current doctors office name which is Pediatrics West. In that letter as well does not show their doctors name. In addition to that the change was made because apparently their doctor is affiliated with ***********************. But when the system automatically selected their PCP that new PCP is also affiliated with ******* hospital so I am very confused why their PCP is no longer in network as apparently she was removed because she is affiliated with ******* Hospital. The change was made on July 1, 2024, which is also the same day of the visit. I would really like to have this looked into as I find this very frustrating.

  Business Response

  Date: 08/30/2024

  Your complaint has been received. Harvard Pilgrim will investigate and provide a response with the findings directly to you in writing within 30 days at the address on file. Thank you for bringing this matter to our attention. Please contact Harvard Pilgrims ************************* at ************ if you need assistance in the meantime.  Thank you.

  Customer Answer

  Date: 08/30/2024

  Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered. 

  [You must provide details of why you are not satisfied with this resolution.  If you do not enter a reason for your rejection, your complaint will be closed as Answered.]

   

  Based on their response they will take 30 days to investigate which means this case isnt closed. As a result I would like to keep this opened until they have a resolution. Thank you.
  
  Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
  
  FAQ
  
  Regards,

  Ria

   

   

  Business Response

  Date: 09/03/2024

  For further discussion regarding your complaint, please contact Harvard Pilgrims ************************** at ************.