Complaints

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

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  Moda Health

  601 SW 2nd Ave Portland, OR 97204-3229

• 

  Moda Health

  PO Box 40384 Portland, OR 97240-0384

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:06/09/2025

  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.

  Payments to my provider.This has been an ongoing issue since Aug. ***** provider was to receive payment from MODA and hasn't.The incorrect mailing address was on file & box 13 on claims form marked.1/15/25 called to make sure the correct address on file told me it had been updated & checks would have stop pay on them & reissued to correct address.2/12/25 told by ******** call logs were never followed up on or closed & claims were never submitted call ref#************ spoke with ***** (manager).3/28/25 talk to ******* very nice & assured me checks are currently in progress but delayed in accounting as soon as accounting finishes processing they will be sent out in next couple weeks.He spoke to ****************** **** & was told I would receive pmt in next couple weeks. 4/29/25 spoke with ******* a stop pay & reissue on checks & were sent to the incorrect address again 4/1/25 .He sent claim to accounting to have another stop pay & checks resent in one payment.5/8/25 was told pmt is still in processing & I should see it in 7-14 business days.5/14/25 spoke to ***** told me accounting **** needed more info from representative(*******) told she'd reach out to him & then a manager to get this fixed. 6/6/25 checked on status was told they were sent for processing & can take ***** days to process. Asked to speak with a manager & was transferred she answered then hung up or got disconnected & was never called back. Spoke to ******** was told manager ***** was in meetings all day, I asked to speak to another manager & was told she's the only 1. I asked to speak to **** the other manager was told he is "actually a supervisor not a manager", I said can I talk to supervisor ****, she told me he was busy & she would forward on to ***** (supervisor) to see if she can talk to accounting & expedite payments. I asked if I should call back to check on status she said if I don't hear from her to call the 800# & ask for her or anyone who answers is able to check the status of claims.

  Business Response

  Date: 06/10/2025

  Moda Health received the formal complaint filed by Ms. ******** on June 9, 2025.  We will respond to her complaint in writing within 30 days.  Thank you.

   

  Customer Answer

  Date: 06/10/2025

   
  Complaint: 23444826
  
  I am rejecting this response because: This has been on-going issue since August of 2024 & I have called multiple times to have this resolved only to have been told I would see a resolution for the problem within 7-14 business days, ***** days, within 6-8 weeks and so on.  My provider has yet to see payment on her end. The account I have is past due and I had to set up a payment plan with her to cover the expenses that are modas responsibility. She is no longer able to accept moda because of this issue. I now have to seek help elsewhere. I am not satisfied with the 30-day response I have given them multiple opportunity to send out payments. I need to have her paid in full ASAP. 

  Thanks
  
  Sincerely,
  
  ****** ********

  Customer Answer

  Date: 06/23/2025

  Hello,
  
  I'm writing in regard to complaint ID# ********.
  They have issued payment in full the day after they were contacted.
  I appreciate the help in resolving this matter. 

• Initial Complaint

  Date:06/01/2025

  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.

  In September, 2024, my wife and I went to Primary Health, on Broadway in ***** to get flu shot and covid booster. Was told that we were not covered by insurance. Went home and called ******************** (our provider), and asked why we were not covered. Our premiums were up to date, and were told we would be covered for the vaccines. My wife and I were covered on the same policy. Moda called the Primary ***** office that turned us away, and verified that we did in fact have coverage, and that the vaccines would be covered.We talked to the office manager at that facility and she said we would be covered. We went down, got the vaccines, and later, I was billed for my vaccine ($335). My wife was covered (we have the same policy, I am on her insurance). ************ billed the wrong insurance for my vaccine initially, then months later tried to **** Moda. By then, my wife switched us to another health care provider. Moda denied my claim because I am no longer with Moda. Now, in May, 2025 I am getting collection notices from ************ for $335 for my vaccines. I did open a complaint with Moda, and they still denied me, even though they paid my wife's vaccines, and not mine, even though we are on the same policy, and policy was in effect when we got the vaccines. These acts are arbitrary and capricious. Moda, and ************ need to be investigated for injury and anguish because of their actions and false statements made to patients, and wrongful business practices.

  Business Response

  Date: 06/02/2025

  Moda Health does not have a claim on file for James Megaw for the date of service 9/12/2024, this is the date Shari Megaw had her vaccines.  The provider has 12 months to bill Moda Health for services.  Mr. Megaw should contact the provider and have the office send the claim to Moda Health.  Thank you.

  Customer Answer

  Date: 06/02/2025

   
  
  Complaint: 23404893
  
  
  
  I am rejecting this response because:
  
  I refused to be put into collections for this, as Primary Health sent me nasty letters wanting paid.   Typical response from Moda that it is someone else’s fault.   Take responsibility and pay me the $335 as the reimbursement for the amount I paid.   

  You have my permission to contact Primary Health to about this and ask them why they never billed you.  
  

  I will continue to complain about this until it is handled to my satisfaction.  I will not accept anything other than Primary Health and Moda correcting this wrong. 
  
  
  Sincerely,
  
  
  
  James Megaw

• Initial Complaint

  Date:12/19/2024

  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.

  The nature of this dispute involves overcharging premiums, not sending reimbursements, and not being able to talk to anyone at the company who can answer my questions or explain why I have been overcharged and terminated multiple times. Moda Health is through *********************************** and both companies are reporting different information to me about my policy. I am owed hundreds of dollars and I cannot get anyone to explain this situation to me or help me figure it out. I have proof from both companies that show a major discrepancy and I am happy to provide these documents below. I am also due a reimbursement from months ago that has not been returned to me by Moda. Earlier in the year, they tried to automatically take over $1,000 from my bank account and I had to put a stop-payment on it. They have very shady business practices and I am willing to say that they are downright stealing money and not reporting premium payments to ***********************************. Moda is currently supposedly doing an audit on my account to figure out this issue, however, I do not trust them to do it accurate, honestly, or timely.

  Business Response

  Date: 12/20/2024

  Please have this person provide their member identification number, birthdate and or address so that we can confirm that we are addressing the correct member.  Thank you.

   

• Initial Complaint

  Date:12/09/2024

  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.

  On 9/24/2024 My daughter had her annual check up. In early December her provider told her **** had rejected the claim and stated they had my daughter's DOB incorrect. I called Moda to fix the issue and they refused to help telling me to contact **** and my employer. Both of which referred me back to ****. I called Moda multiple times and they refused to do anything. I have now had to pay the claim out of pocket to avoid it going to collections and am out several hundred dollars.

  Business Response

  Date: 12/10/2024

  As Moda Health is this family's insurance coverage, all eligibility matters need to be addressed by the employer.  If there is a change to the daughters birthdate needed, the member needs to contact the employer, they will update and the updated information comes via a tape download to Moda Health.  Once the date it updated the claim needs to be submitted for processing.  The member can contact OEBB at Email: ************************************

  Phone: ************.  Thank you.

• Initial Complaint

  Date:09/04/2024

  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.

  In 2023 my health insurance was with Portland-based MODA. In December 2023, I was approved for SSDI through the **** As part of that approval, I was given ******** retroactive to October 1, 2023, for ******** Medical, and retroactive to July 1, 2023, for ******** Hospitalization. MODA mistakenly found that ALL the coverage was retroactive to July 1, and that they (MODA) were therefore not responsible for all claims starting July because ******** was actually my primary coverage. MODA erroneously clawed back about roughly $10,000 from providers for claims between the start of July and the end of September. The providers began seeking those payments from me. I alerted MODA to their mistake 4 months ago, sent them the *** documentation making it crystal clear that medical claims before October are indeed their responsibility, and they are refusing to make things right.

  Business Response

  Date: 09/06/2024

  We will not be providing a response to your office as this member filed a complaint with the Idaho insurance division and we received the complaint yesterday.  We will do a through review of the complaint and will respond to the Idaho insurance division.  We have 14 days to review and respond.  ********************************* will then respond to the member with their findings.  Thank you.

  Customer Answer

  Date: 09/25/2024

  Regarding the letter I recently received from BBB via E-mail about my complaint against MODA Health, the matter remains unresolved.  I'm unaware of anything being done by MODA to remedy the situation.  Meanwhile, the collections letters from various healthcare providers are piling up on my desk because of MODA's mistake, outlined in my original complaint with BBB.   
  
  **** *********
  ************

  Business Response

  Date: 09/27/2024

  We received this case through the ************************************. This member filed a complaint.  Moda Health is currently working with the insurance division about this case.  This member should reach out to the insurance division for updates.  Thank you.

• Initial Complaint

  Date:08/26/2024

  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.

  I was unable to access crucial documents in the portal and there were no customer ********************** representatives available. As a result, I missed a special enrollment period and will not be covered for the remainder of the year. This is going to have devastating financial repercussions for me. In addition to that, there have been several other times I was not able to access my information or a representative or use the portal properly. This is completely unacceptable and I regret purchasing Moda, as I am now under the impression it is operating like a scam or is simply providing a useless service. I expect to be refunded.

  Business Response

  Date: 08/30/2024

  Thank you.

• Initial Complaint

  Date:07/19/2024

  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.

  Moda health is refusing to pay for a medical procedure done and covered under womens health in my insurance handbook. I have called them over 100 times to get things they claimed they needed to be able to pay for this. I have supplied them with prior authorization numbers, claim codes, billing numbers, doctors notes, etc. I am calling them again in July of 2024 because the bill is now outstanding and they claim that this bill no longer exists. It still very much does exist with Good Samaritan billing and Im going to be taken to claims for it. They are also refusing to pay for a well child visit for my daughter who was 8 days old at the time. **** is being fraudulent by deleting the claim that I have requested them to pay for. I have called them today 7/19/2024 at 1:43 pm and they still claimed to not have it. I produced the claim number and magically it appeared on their end. They still wont pay for it despite it being covered under womens health. This company has cost me irreplaceable time, mental health, and my own money for this things that we pay our insurance to pay for. Mentally I am sick with the amount of effort I have put into doing these peoples jobs. I am seeking compensation for my efforts, and the stress this has caused my family and I. ************* should be investigated for insurance fraud. My primary care office can attest to how many things I have done for moda, and that they have sent the required documents for moda. My provider is *** ****** in ******, Oregon.

  Business Response

  Date: 07/22/2024

  We read through this concern.  The complainant does not provide the names of provider, dates of service or any specific claim information for Moda Health to identify what claims are not being processed.  Can you please reach out to the complainant to have them provide more information to Moda Health.  Thank you. 

  Customer Answer

  Date: 07/22/2024

   
  Complaint: 22015996
  
  I am rejecting this response because: they already have all of this information on file. Or every customer ********************** representative has lied to me. 
  
  Sincerely,
  
  *************************

  Business Response

  Date: 07/29/2024

  Thank you.

  Customer Answer

  Date: 07/29/2024

   
  Complaint: 22015996
  
  I am rejecting this response because:

  they still have not fixed the issues. I owe $900 that should be mostly covered by insurance. 
  
  Sincerely,
  
  *************************

• Initial Complaint

  Date:03/28/2024

  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.

  I signed up for Moda Health Insurance prior to the 2024 year starting. I had all payments for health insurance premium on autopay from the year prior. I checked online and verified this and also made sure my dental insurance was an auto-pay. I found out in early March that my health insurance was somehow not in effect, so I contacted Moda. My autopay was not going through, and so I offered to pay all back pay and make sure my autopay was correct. Instead, a week later they called to tell me they were dropping my coverage after sending two letters informing me that my payments were delinquent. There was no phone call or email prior to this point, and I did not see the letters they mailed. Despite my plea of wanting to cover the missed payments and resume coverage, they cut me, leaving me unable to get health insurance otherwise since I'm no longer eligible. I'm no longer eligible BECAUSE I signed up for Moda on time. The year prior there was an issue with autopay and Moda allowed me to backpay and rectify the situation and keep my health insurance.

  Business Response

  Date: 04/04/2024

  Thank you.

• Initial Complaint

  Date:03/18/2024

  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.

  MODA Insurance had me set up on EFT payments for my monthly premium. They correctly did an EFT for ******* of 2024, then somehow on their end did not continue to do EFT for my premium from my bank account. And yes there were funds available, they just didnt perform the transaction. They cancelled my insurance policy and I now have no coverage until a new policy starts. This also leaves me with pending medical claims that they approved through a pre authorization.

  Business Response

  Date: 03/26/2024

  Hello- We also received an insurance division complaint filed by this member.  We are investigating the matter and will have a response by 4/9/2024.  Thank you.

  Business Response

  Date: 04/02/2024

  This is in response to the complaint received at Moda Health on March 18, ********************************** 
  ********* premium and eligibility for the 2024 plan year. 
  

  ******************** became active on an Oregon Individual Plan, purchased directly through the Federally Facilitated 
  Marketplace (***) effective January 1, 2021 with no lapse in coverage. Per the **** she did not qualify for an 
  Advanced Premium Tax Credit (APTC). Effective January 1, 2024, ******************** is on the Moda Health Bronze Plan. 
  

  In the complaint, ******************** explains that Moda Health had her set up on electronic funds transfer (EFT) for 
  her monthly payments. Moda Health correctly withdrew funds for the January 2024 premium but did not continue 
  to withdrawal her premium payments when funds were available in her bank account. She states that Moda 
  Health terminated her policy and she no longer has coverage until a new policy starts. This leaves her with pending 
  medical claims that have been approved through prior authorization. Ms. ********* desired settlement is to 
  receive billing adjustments. 
  

  On the Moda Health Bronze Exclusive ********************* (EPO) Plan, eligibility and enrollment are 
  administered by the Marketplace. Contact the Marketplace for information. You must tell Moda Health and the 
  Marketplace whenever your address changes. The amount of premium you owe is shown on your premium notice.
  You may contact the Marketplace about premium tax credits. We must receive your premium payments every 
  month to keep your coverage active. You can pay by check, cashiers check, money order or prepaid debit card 

  with a billing statement, or by electronic fund transfer (EFT). Electronic billing (eBill) is also available. This lets you 
  pay your monthly premium on your Member Dashboard using your bank account. 
  

  These circumstances will cause your coverage to end: 
  

  a. The subscriber is no longer eligible for coverage through the Marketplace 
  b. The subscriber moves outside the Plans service area 
  c. The dependent is no longer eligible as a dependent 
  d. Premium is not paid 
  e. Subscriber ends coverage after the required advance notice or changes plans during an open enrollment 
  or special enrollment period 
  f. Rescission for fraud or intentional material misrepresentation
  g. We end this health benefit plan option
  h. We are decertified to offer plans through the Marketplace
  

  Coverage ends on the last day of the month through which premiums are paid unless otherwise required by law. 
  If your coverage was paid with financial aid in the form of tax credits through the Marketplace, coverage ends on 
  the last day of the first month of the ***** period.
  

  This information can be found in the enclosed Moda Health Bronze EPO Plan handbook pages 56-58.
  

  We thoroughly reviewed the complaint. Please see the below timeline of events:
  

  1. October 6, 2023: Ms. ********* 2024 eligibility was received by Moda Health from the ***.
  2. November 14, 2023: Moda Health received the ***s request to terminate Ms. ********* policy effective 
  January 31, 2024. 
  3. November 16, 2023: The *** sent Moda Health a plan change making Ms. ********* policy active 
  effective January 1, 2024 with no change to the termination date (effective January 1, 2024). 
  4. November 16, 2023: Moda Health sent ******************** a termination letter (enclosed). 
  5. December 6, 2023: ******************** called the Moda Health Customer ********************** Department and was advised 
  she is set up on electronic funds transfer (EFT).
  6. December 7, 2023: Moda Health sent ******************** a final premium notice (enclosed). 
  7. December 20, 2023: Moda Health sent ******************** a plan continuation letter (enclosed) reflecting an 
  effective date of January 1, 2023.
  8. January 10, 2024: Moda Health sent ******************** a plan continuation letter (enclosed) reflecting an 
  effective date of January 1, 2024. 
  9. March 18, 2024: ******************** contacted the Moda Health Customer ********************** Department to discuss the 
  termination of the plan. The Moda Health agent researched and called ******************** back the same day 
  to advise her that termination came directly from the ***. 
  10. March 18, 2024: Moda Health received the Better Business Bureau (BBB) complaint that Ms. *************************************************** was set up on EFT and Moda Health successfully received her premium payments through January 
  31, 2024. Moda Health was advised by the *** to terminate her policy effective January 31, 2024. For this reason, 
  the EFT was also terminated, and premium payments were no longer withdrawn.
  

  We understand that Ms. ********* desired settlement is to receive billing adjustments. Moda Health has 
  processed the claims, with service dates January 1, 2024 January 31, 2024, in accordance with the plan. Moda 
  Health has not received and/or processed any claims for ******************** with service dates February 1, 2024
  forward. If ******************** would like to continue coverage, she will need to discuss with the *** as directed during 
  the call she made to Moda Health on March 18, 2024. 
  

  We appreciate the time ******************** took to share her concerns with us, and we understand the situation as it 
  has been explained. However, we are unable to comply with her request for benefits. We are required to 
  administer benefits in accordance with the *** and the Moda Health Bronze EPO Plan. If she has follow-up 
  questions, we welcome her to contact our Customer ********************** Department. They would be happy to assist her.
  

  Questions? Please call our Moda Health Medical Customer ********************** Line at ************ or Pharmacy Customer 
  ********************** Line at ************. TTY users, dial 711.
  

  Sincerely,
  
  Kacee 
  Appeal Coordinator II
  Moda Health Appeals Department
  

  
  

• Initial Complaint

  Date:02/05/2024

  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.

  I was enrolled in their ebill autopay for $70 a month. The plan was never renewed. They renewed it and took $3.715. 86 out of my checking account without my authorization.

  Business Response

  Date: 02/05/2024

  Hello,

  We are not able to identify this person as a Moda Health member.  Please provide a member identification number so that we can look further into this concern.  Thank you.
  

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

  Supervisor, Member Appeals for Moda Health