Business Profile

Medical Plans

Meritain Health

Headquarters

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Complaints

This profile includes complaints for Meritain Health's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

20 total complaints in the last 3 years.
12 complaints closed in the last 12 months.

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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:05/28/2025
Type:Billing 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.
Since January 2026 I have been trying to get reimbursed for infant formula as my daughter has a cow milks allergy diagnosed by her pediatrician. My health insurance plan documents state that infant formula is covered at 70%. I have made countless calls and emails trying to get this sorted out. They are purposefully delaying and denying my claims. And to add Insult to injury they are sending the incorrect payments (nowhere close to 70%) to the provider who wrote the prescription; not to me who is paying out of pocket. Unacceptable and zero accountability. I want this resolved.
Business Response
Date: 06/02/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 06/02/2025
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. "Please provide me with the following information so that I may research this matter and try to bring this to a resolution: group health plan name and number, full member ID number, subscriber name, and name of the employer." See below requested details: Plan: ***** ****** *** ** Member ID: ********** Group: ***** Division: *** Member: ******* ******** - My wife. DOB ********** (Employer: ********** ******** *******) Also covered by this plan are: ****** ******** DOB ********** (self), ***** ******** DOB ******** (Daughter) - who these claims for infant formula have been sent for. The plan covers 70% of infant formula when prescribed by a doctor for a cow's milk allergy. I have a pre-determination form on file stating that my family is eligible for this benefit. Yet YTD I have gotten $4.50 back (and they sent it to the pediatrician not even us!). Meanwhile we spent over $1,200 on ********* formula YTD. You are putting me through hoops to get this trying to get me to give up. I've submitted claims each month of the year, January, February, March, April and May. They are processed incorrectly. I purchase the formula in bulk from ****** as my daughter ***** takes about a ready-to-feed bottle of it per day which is 32oz. I buy 12 containers every 2 weeks from ****** through their Subscribe and Save plan. I would like to be reimbursed 70% for my claims as my plan states I am entitled too. The amount of financial stress on my family at this time is insufferable. Please assist with my claims.

Regards,

****** ********
Business Response
Date: 06/06/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 06/09/2025
Code: ************* Hello, I saw Meritain Health sent back HIPAA release forms for my wife to sign before they can look into my request. My wife filed these electronically this morning on 6/7/25 on the Meritain website. I could not respond back to Meritain's attachments to let them know this so hoping you can forward this on to let them know so they can promptly assist. Thanks! ***
Initial Complaint
Date:05/02/2025
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.
Denial of Cancer treatment
Business Response
Date: 05/05/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 05/05/2025
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.

I have attached the PHI I do not have access to a fax I will have to mail my authorization to Meritain. I have attached a copy of what was mailed to them

Regards,

****** ********
Business Response
Date: 05/06/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Initial Complaint
Date:03/25/2025
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.
I have a HSA account where I get reimbursed $220 monthly for my health insurance premiums through the ******* ****** ********** website which I guess is now managed by Meritain Health. In Feb of this year I did not get a health premium reimbursement for service dates 2/1/2025 to 2/28/2025 and when I contacted three different people at Meritain they all said I was reimbursed for Feb on Jan 25th, but the service dates on my account show that payment was for service dates 12/25/2024 to 1/25/2025 and the next payment after that paid in March 2025 was for service dates 3/01/2025 to 3/31/2025. Based on their own records I have not been reimbursed for service dates 2/1/2025 to 2/28/2025, but they keep insisting I have.
Business Response
Date: 04/02/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 04/02/2025
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint. I gave my information you are requesting at the top of my letter that was included in my original complaint. I am a retired employee formerly worked for ******* ****** *********. My RHS Plan number is ****** and my Participant Account ID is **********. I am supposed to get monthly direct reimbursement for my monthly health insurance premiums with ****** **** ** ******. My Member ID with HPN is ************ and my Group Number is *************

Regards,

**** ******
Business Response
Date: 04/08/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 04/08/2025
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.
I am not a member of Meritain I am a member of ******* ****** ********** and Meritain is the Third Party Administrator for my Retirement Health Savings Account I had with ******* ****** *********. The only number that appears on the website is my participant ID number which is **********. If you look at the two attachments it shows Meritain as the member support for ******* ****** ********** located in Lansing Michigan. When I log in to my ******* ****** ********** account and click on "Reimburse Me" the pop-up window displays that I am leaving ******* ****** ********** website and going to Meritain Health website because they are the third party administrator for my RHS account.
Regards,

**** ******
Initial Complaint
Date:02/26/2025
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.
My child was born in May of 2024. Me and my girlfriend are not married, but both have separate policies with the same insurance company. We have had multiple issues, runarounds, and just wrong information given. We are getting to a point where they are attempting to push our birthing bills to collections when we have been trying to get this settled for almost 5 months.

Here are some fast facts:
1. We paid an out-of-pocket coverage cost of $3k before leaving the hospital
2. The baby was supposed to be on the mothers insurance for the first 30 days
3. For whatever reason, the insurance denies the claim saying the mother didnt have coverage during birth. In the policy, it clearly states the mother is covered for the first 31 days of birth until the baby is moved to the actual primary insurance
4. as stated earlier, we have the same insurance providers, but different policies. It should not be this long and difficult for Meritain to identify discrepancies in policies for their own customers
5. We are tired of the run-around and the billing is not making any sense nor can anyone at Meritain make sense of the billing. This is leaving us in limbo because our own insurance company is doing everything in their power to make this difficult
6. Are they purposely trying to push charges to collections because its easier for them? Why is it so difficult for two policies in the same damn building to be corrected?

Like ***, it's all in-house!!!!
Business Response
Date: 02/27/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Initial Complaint
Date:02/22/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I keep getting letters from a hospital I was treated at that Meritian Health is not responding to a claim. On my side they keep telling me it is still processing with zero information on why. This has been going on for months. I have reached out to both to ask them to talk to each other but Meritian won’t give me any answers on why they are delaying my claim.
Business Response
Date: 02/25/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Initial Complaint
Date:01/14/2025
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.
On 1/7/2025 ****** ****** ****** ****** received a notification that our patient's insurance company, Meritain Health, was denying coverage for a Breast MRI and they were requesting a peer to peer conversation to discuss coverage. Dr. *********** was directed to call Meritain Health for a Peer to Peer by calling ************ on case number *******. When Dr. **** ****** called this number, she reached a voicemail box which instructed to leave a detailed voice message and not to leave multiple messages. Between 1/7/2025 and 1/13/2025, Dr. *********** left two voicemails requesting a time for a peer to peer with detailed case information. Neither Dr. *********** or our office received any calls or communication from Meritain Health. On 1/14/2025, our office received a fax from Meritain Health stating, "Please let Dr *********** know the reconsideration time period has ended. No longer eligible for Peer to Peer. Please see attached letter for appeals option. Thanks." The letter also stated, "If you have any questions regarding this letter, you may contact us at ***** *********" On 1/14/2025, I (Dr. ***********'s RN) had seven different phone conversations with representatives with Meritain Health. Each phone call, I was requesting for our patient's case to be reopened because it was the company's error that the Peer to Peer was not completed in time. Each and every phone call I was transferred to a voicemail box which was called "The Provider Voicemail for Reconsideration." I repeatedly asked not to be transferred to this line and was transferred anyway. This company is actively delaying patient care by not responding to our requests for negotiation.
Business Response
Date: 01/21/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 01/22/2025
So on my end, I see no response from the company. There has been no information presented on a resolution. It looks like the communication was referred to but not attached.
Business Response
Date: 01/23/2025
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 01/23/2025
Per the patient's request, she would like this case closed because she has changed insurances.

Regards,

****** **********
Initial Complaint
Date:01/12/2025
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.
My husband and I were on an ***** plan that was administrated by Meritain. At the beginning of the year, I had surgery and shortly afterwards met my out-of-pocket maximum for the year. As my husband was turning 65 in October, we started in June speaking with Meritain to see what would be most cost effective. Meritain agreed that I could stay on the plan myself and I would get a new card and number but that my out -of- pocket would be carried over with a new number. (We also got this in writing) October 1st came and nothing had been done. I had zero to my deductible or out of pocket. After multiple calls, Meritain changed everything on their end. However, they work with ******** and they needed to have them execute changes on their side. Several weeks later ******** had updated my account but for whatever reason it showed I still had $300 to meet my out-of-pocket maximum. Thus, for the remainder of the year I had to pay a copay of which should have been zero. I made call after call and spent hour after hour being transferred around and put on hold. I worked with two different Meritain resolution specialists. Both of them followed up with me a few times and then dropped me. Each time I was told they are working on it. I had an advocate from ******** that called me faithfully every Wednesday for three months whether she had information or not. She told me that Meritain refused to put an “override “in the system and then she said as of December Meritain refused to take her calls. Meritain finally did reimburse me some of the money that I had paid but I am still owed around $60. Its not a lot of money but it’s the principle of it. Nobody at Meritain took any accountability for to helping me and just kept passing the buck. Also, in 2024 I had an issue regarding a charge that Meritain didn’t pay. I finally filed a grievance and never received a response. Another example that Meritain is not working for the consumer.
Business Response
Date: 01/22/2025
Good evening, This is to acknowledge receipt of this complaint. This will be researched by our Operations team with a full response shortly to follow.
Customer Answer
Date: 01/23/2025
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.
I am not accepting because all that the message said was that they have received my complaint from the BBB and will review it and get back to me.

Regards,

******** *****
Business Response
Date: 01/29/2025
We are working on researching this issue for our member. She has issued a secondary complaint and will respond accordingly.
Customer Answer
Date: 01/29/2025
I have rejected responses from business because both have said they are still researching the problem. They have offered no resolution or solutions. They have not contacted me. They have all the information they should need. . I signed the Hippa releases and all they have to do is pull up my account and read all the documentation of phone calls that I made over the last three months of 2024.. they also have access to look at my account and see I had met my out of pocket maximum for the year and see that ******** of whom they contract with inaccurately updated information and I had to pay copays for medication for the rest of the year. I am not computer savvy and when I go to sites I can see error as clear as day. ******** *****
Business Response
Date: 02/10/2025
Good afternoon, Please see attached response and be advised all claims have been adjusted. Thank you.
Initial Complaint
Date:11/25/2024
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.
This insurance is genuinely the worst I have had, and this experience is the worst I have had, medical-wise, to date. I received a call from Lois, my case manager, on Oct 11th, 2024, to let me know I was approved for a bariatric surgery with ******. I had multiple appointments after this approval to prep (including chest x-ray, EKG, blood work, and check-ins that I had to keep). My surgery was scheduled for Nov 27th. I had already paid the remainder of my out-of-pocket cost, which was $3,699.66. Lois - my case manager, called me at 5p on Nov 22nd to let me know she 'did not read the fine print' and that I was not, in fact, approved that my employer denied the claim.

She then tried to blame the 'fine print' on me. How would approved not mean approved? I have a copy of the approval notice that says approved. What more would I personally need to check? She then said she tried to call me the week prior, but I have no phone record of that attempt. She did not mention any additional attempts after. The only other call I received was after business hours on a Friday before I was supposed to have the surgery in 5 days. Lois waited as long as possible to call and admit her mistake. She couldn't connect to a manager because her 'phone doesn't do that' and she couldn't verify with my employer because shes 'not allowed to call them directly. All of which are excuses for this mistake.

She mentioned that this has happened with other cases prior - if that is true and she is aware of the issue, why was my paperwork not thoroughly checked? I spent thousands of dollars due to Lois' mistake. ****** will take over a month to refund my $3,699.66. Additionally, due to Lois' mistake, I will not get the money back for the other appointments I had after the approval. I was also on day 10 of a 14-day liquid, which ended up being not medically necessary due to Lois' mistake.

Her story on the phone was not adding up. This mistake cost me a lot of time and money and stress.
Business Response
Date: 12/05/2024
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Initial Complaint
Date:11/18/2024
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.
Papers were submitted to Meritain in September for a DME company to be paid as “in network” for necessary medical supplies for my daughter. They claimed they did not receive them. Forms sent again. Then they couldn’t find them. They finally found them and they were under the wrong claim. I called back in October and they were working on request. I called back several times to check on progress. Meanwhile I was paying out of pocket for supplies. The last phone call was on 11/7/24. The claim was escalated to the resolution team. It was to be 3-5 days for an answer. Today is 11/18. The claim was sent to the wrong department. Total incompetence for this level of service!!!
Business Response
Date: 11/22/2024
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 11/25/2024
This is in response to the complaint I made on 11/22/2024. #********. With Meritain Health. Patient name:******** ***** Provider name:**** **** ******* Claim on 09/10/2024. *******. **** **** ******* had requested a single case agreement. Amount of claim $3197.50.
Business Response
Date: 11/26/2024
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 11/27/2024
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.

Regards,

****** *****
Initial Complaint
Date:10/09/2024
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.
Issue # 1. I have a dental policy under Meritain Health. In the month of September my dental provider sent in a pre treatment estimate under EOB 647C817 for $1918.00. It took the carrier several weeks to process this pre treatment estimate. Then they came back requesting additional info. I emailed the carrier and advised them that they already have this info when the dental provider originally pre treatment estimate back on 2/23/2023 under EOB 6271R74 and it was approved. Customer service both told the provider and me that the pre treatment estimate was only good for 6 months so we needed a new one. The carrier is refusing to approve this pre treatment estimate even though they have the same info and approved the previous one.

Issue # 2. Every time I call customer service at 800-765-4224 the CS reps transfer me to Allstate Health Benefits which I do not have nor can they help.

Issue # 3. I contacted Aetna’s Social Media Resolution Team on 10/07/2024 at 02:58 PM and advise them of the issues and they stop responding and did not address the issues.
Business Response
Date: 10/25/2024
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 10/28/2024
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.
[They did not address this issue about when I call customer service at ************ the CS reps transfer me to ******** ****** ******** which I do not have nor can they help as they can not access my policy.

Regards,

***** ******
Business Response
Date: 11/14/2024
The business has responded to the complaint but due to the sensitive nature of the complaint we are unable to provide the business’ response for public viewing.
Customer Answer
Date: 11/19/2024
I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.

[Do not know why Code ***** for $347.00 is not covered and has this listed a. Benefits are not approved for the crown buildup. The plan allows for benefits for a crown buildup only for teeth that are non-vital (having undergone root canal therapy).

Regards,

***** ******

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