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:01/29/2024

  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 signed up for insurance with Moda through the ***** exchange to start 12/1/2023. Later in December I learned there was an issue with my premium payment, so I called and gave them my bank info - at that time I was assured their billing department would pull my payments from my bank and that I would be enrolled in autopay. In January I realized I still didn't see money withdrawn from Moda and called again - Moda Health had canceled my insurance due to lack of payment and hadn't sent me a single notification about it. They told me I was in a grace ****** so if I paid my ****************** premiums and enrolled in autopay I could get back on my insurance. I agreed and once again gave them my banking information. That was four business days ago and every time I call, the customer ********************** rep just tells me it's "with their billing department" and that it should be done soon. Meanwhile I have no health insurance and am at-risk of losing insurance for the entire year since we are no longer in open enrollment. I would like someone at Moda to just take the money from my bank account for the premiums, reinstate my insurance, and put me on autopay as I requested over a month ago.

  Business Response

  Date: 02/06/2024

  Thank you.

• Initial Complaint

  Date:12/13/2023

  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.

  Over the past three years i have been dealing with a misdiagnosis of GERD when I could still afford health insurance. I changed my diet, lost weight, and shifted all of my eating schedules around a GERD diagnosis. Only recently had I been able to afford health insurance, at least I'd thought so. Upon going to healthcare.gov to search for easily laid out information on how to select health insurance I went down the rabbit hole that is the intentionally confusing and awfully marketed plans meant to confuse and mislead consumers. The plan I selected ended up being under MODA health insurance. Since then, I have spent thousands and thousands of dollars getting multiple tests, seeing multiple different types of doctors (ENT, FP, GI) all to be diagnosed with Achalasia II and recommended for a POEM's procedure. This was about 4 months ago. MODA was forcing me to go out of state (where they wouldn't cover basically any of the cost of travel, housing etc.) and would not approve an out of network doctor in Alaska. They then denied me setting a date for THIS year by denying guided anesthesia which is incredibly normal for a surgery just got it to get pushed back to around the date i had it scheduled for, so I'd be FORCED to pay them more money and have the surgery be for NEXT year. they have 3 different types of deductibles that aren't mentioned when signing up on the healthcare.gov website without intensive digging. this is supposed to be for those who can't afford private insurance and need the aid, clearly, it's not. it has put me in debt just seeing the 4 different doctors and only having 3 tests that have somehow added up to almost $7500 dollars and that's just the tests! not any of the extra costs like taking my *** deductible and then almost my *** out of pocket. I have nothing to show except tests results, debt and now i need to find a way to afford insurance that won't try to steal my money. this isn't right. I am willing to press charges. This is health extorsion.

  Business Response

  Date: 12/15/2023

  We are sorry to hear about ********************** concerns. We are unsure, however, what it is exactly that he is wanting from Moda Health.  If he has a quality of care complaint about the medical care he has been provided and received by specific provider's, he can write to Moda Health and give details about his experiences.  We would need medical records from the clinicians that he has concerns about to review the complaint. ****************** also speaks about the thousands of dollars he has paid for services.  We would encourage him to log in to MyModa and create an account.  He can access his plan benefits here too so that he can understand the plan requirements, benefits and cost share for services in and out of network. We have no prior authorization on file for the **** procedure that ****************** speaks about and no requests for an in network benefit exception that has been denied.  The only denial on file is for a CT scan for his neck.  If ****************** disagrees with this denial, he may appeal.  In the denial letter he was provided appeal rights.  As for the Federally Facilitated Marketplace (***) not providing all deductible amounts for the medical plan that ****************** selected, Moda Health has no control over what the *** posted about our plans. We are sorry for ********************** frustrations. Please have him reach out to customer ********************** at ************ if he needs additional assistance.  Thank you, **********, Moda Health

• Initial Complaint

  Date:08/15/2023

  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.

  While applying for health insurance on, June 30th 2023, Moda employees informed me that I would not be eligible for insurance for July. That it was too quick of a turn around time but that I should have insurance by August. I still had not heard anything from MODA by August. On August 4th I received a call about my coverage stating that they received the paperwork but that they needed more information as to why my insurance was canceled. I provided the information and was told that I had insurance for August. I then received a bill for July. I called and spoke with ********************* who informed me that they had backdated my insurance and that I was covered for July even though I was told that I was not covered for July. Even assured me I would not be charged for July since they told me that I was not covered. I was then charged for July anyways. After speaking with a representative today I was told that she would put in a request to refund my money but that she couldnt guarantee I would be refunded because I have no proof.

  Business Response

  Date: 08/29/2023

  Thank you.

  Customer Answer

  Date: 08/30/2023

  To whom it may concern,
  
  There has yet to be a resolution regarding case number ********. I received a voicemail on August 17th that I would be refunded for July 2023. I have still not been refunded. 
  
  Thank you, 
  **************************;

  Business Response

  Date: 09/05/2023

  We apologize for the delay in the refund.  We reached out to our accounting department and we have been told that Ms. ****** should see funds in her account tomorrow.  Thank you.

   

  Customer Answer

  Date: 02/12/2024

  Back on august 15th 2023 I had originally filed this complaint with the BBB While applying for health insurance on, June 30th 2023, Moda employees informed me that I would not be eligible for insurance for July. That it was too quick of a turn around time but that I should have insurance by August. I still had not heard anything from MODA by August. On August 4th I received a call about my coverage stating that they received the paperwork but that they needed more information as to why my insurance was canceled. I provided the information and was told that I had insurance for August. I then received a bill for July. I called and spoke with ********************* who informed me that they had backdated my insurance and that I was covered for July even though I was told that I was not covered for July. Even assured me I would not be charged for July since they told me that I was not covered. I was then charged for July anyways. After speaking with a representative today I was told that she would put in a request to refund my money but that she couldnt guarantee I would be refunded because I have no proof. My refund was issued and my complaint was resolved. Then my insurance was canceled without notice. I had signed up for auto pay and was receiving letters from MODA about policy changes for the upcoming year (2024). I had also received my insurance card and letters letting me know my auto pay was drafted. I had no reason to believe my insurance had been canceled. I was reviewing my benefits online today to find that my policy was no where to be found. I called MODA and was told that I dont have a policy with them. They then told me that my policy was canceled in august because they needed more information about my previous policy being canceled. I explained that I was in contact with ***********************, he had requested additional information back in august and I emailed him that information. He told me the information had been accepted and everything was fine. I have records.

  Business Response

  Date: 02/26/2024

  Thank you. 

• Initial Complaint

  Date:06/09/2023

  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.

  I have continually communicated with various agents at Moda Health requesting receipt information to submit to the *************************** for financial assistance.I have been trying to get this information for about 3 months now. Every time I get a response from Moda Health I receive information that is not what I asked for.I am currently waiting for a call back from a manager or supervisor. I was told they are all in a meeting and will call me back within 24 to 48 hours.This request is not that complicated, I need receipts showing the payments I made toward my premiums from January to present so I can be reimbursed by ***.*** requests specific information on the documents and I explained this to Moda Health agents and everything they have sent me does not come close to what I requested.My previous Health insurance companies have all been able to supply this documentation. Since I have moved to Oregon and been a customer of ********************** I have been having this problem.Attached is the screen shot from the *** website showing the denial of my request for reimbursement from previous attempts to get this documentation from Moda Health.Also attached is the most recent document sent to me from Moda Health. It is not what I requested, it does not include most of the information that I asked for.Each time I go through this process the agent that listens to my request, or if I send an email or letter, it is not what I need. All I want is to be able to get the documentation showing what I pay for my premiums. It has to be from Moda Health and adhere to the parameters shown on the screen shot taken from my *** portal.

  Business Response

  Date: 06/22/2023

  Thank you.

• Initial Complaint

  Date:05/02/2023

  Type:Service or Repair Issues
  Status:

  ResolvedMore info

  Complaint statuses

  Resolved:

  The complainant verified the issue was resolved to their satisfaction.

  Unresolved:

  The business responded to the dispute but failed to make a good faith effort to resolve it.

  Answered:

  The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.

  Unanswered:

  The business failed to respond to the dispute.

  Unpursuable:

  BBB is unable to locate the business.

  Moda has been my medical insurance carrier since January 1, 2023. On January 6 and 24, respectively, I saw ********** health provider for follow-up visits. Section 7.4.8 of the Moda member handbook (see link below) states that "[a] woman may see a womens healthcare provider instead of the *** 360 for preventive womens health exams. This includes follow-up visits resulting from an exam covered under this provision." **** failed to pay the claims for these visits accordingly, however, treating them instead as specialist office visits to which my deductible would apply. As a result, I am being charged approximately $500 out of pocket for these visits. My complaint: I believe that **** is failing to do what its member handbook states it will do for individuals who are covered under its *** 360 plan, which is to effectively treat follow-up visits with women's healthcare providers as if they were follow-up visits with a primary care provider. ****'s failure to do so has created unplanned and unexpected out-of-pocket medical expenses for me as the consumer, which is negatively impacting my family budget and creating undue stress. ********************************************************************************************************************************

  Business Response

  Date: 05/11/2023

  Please see the attached response.  Thank you.  

  Customer Answer

  Date: 05/12/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  *******************************

• Initial Complaint

  Date:04/12/2023

  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.

  My GI specialist has been seeking authorization from Moda for the recommended course of treatment. Moda required that I first try other, cheap medications that are not specific to my condition before they would consider covering the more expensive, specific medication. I tried and failed two medications as directed. My GI reported that after this was complete, they applied again for authorization, and that **** responded that they are refusing to consider this issue any further. The prior authorization case number I was given was B7KUYKBV. I have received zero communication from Moda about this case. I have full coverage from Moda and have for years, and this is not the first time they have been reluctant to or outright refuse to provide the care that is described in their literature. Another time, for a separate issue, they went so far as to say that despite the coverage being described as a $100 copay on their website (I sent a screenshot), because it was described as being covered at 80% (I think) in the patient handbook, it was ok that they covered it at 80%.

  Business Response

  Date: 04/20/2023

  Thank you.

  Customer Answer

  Date: 04/26/2023

   
  Complaint: 19929515
  
  I am rejecting this response because:

  **** stated in its response to the BBB complaint that "Moda Health sent a letter dated April 10, 2023 to **************** that the request was closed due to all prior authorization reviews have been exhausted for Xifaxan. **************** was referred to review the prior denial letter for instruction on how to file an appeal."

  As directed by the PA denial from Moda dated 1-31-23 (referenced within Moda's response to the BBB complaint), further steps in trialing and failing medications have been completed by the patient (myself), and thus the PA for ******* as submitted 4-6-23 or 4-12-23 by *************************** FNP can be reconsidered.
  
  Sincerely,
  
  *****************************

  Business Response

  Date: 05/10/2023

  In the response sent to your office on April 20, 2023 we advised what the member needed to do in order to have this concern reviewed.  At this time the member needs to write in a letter of appeal to Moda Health.  The member can provide any clinical information to support the appeal.  Appeal rights were provided in the denial letters sent to the member and are in the member handbook should have further questions about the appeal process.  Thank you.

• Initial Complaint

  Date:03/20/2023

  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 have been attempting to get Moda to send a check for reimbursement for a claim since October of 2022. I have phoned them every month since and am given no reason why my case has not been progressed but am informed it has been approved. Roughly 3 weeks ago I finally received a voicemail from **** saying a check was in the mail. The check has not yet arrived so I phoned them again and was told the voicemail was made in error and that I needed to contact HR where I work (Oregon ******************************************** to get them to pay MNoda first before **** can pay me. I contacted my HR and they have no clue what this means and were unable to help me. Moda customer support tells me their "hands are tied" and it is up to OHSU now. I am confused: does my employer or my health care provider reimburse me? In the past it was always my health care provider but it sounds like that is not the case anymore according to ****. My case number is ************

  Business Response

  Date: 03/31/2023

  Please see the attached email that was sent to your office.  

• Initial Complaint

  Date:03/14/2023

  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.

  My in-network pharmacy ************** (***************************) at **************************************************************************************** went out of business unannounced to me. Neither MODA nor the pharmacy let me know this. I took my daughter to the dr for an ear infection on February 3, 2023. The Doctor called in the antibiotics to ************** and discovered they were out of business and that all Rx was transferred to *********** in ***** (Address: ********************************************************** Departments: CVS ) When I went to Long's to pick up the Rx late in the evening they charged me 201.16$ out of pocket! I had to pay for this because it was an emergency and the next closest pharmacy was an hour away. Now MODA is refusing to reimburse me for the $201.16 even after submitting a claim saying they don't work with ***** and that I should have driven 1 hr in the dark in an emergency situation for my 9-year-old daughter to another pharmacy that I had no knowledge of, to begin with.I want to be reimbursed for the 201.16$

  Business Response

  Date: 03/16/2023

  Good Morning.  This members mother, *********************, filed an appeal with Moda Health on 3/10/2023.  As this is a post service claim review, we have thirty days to review.  We will be sending a letter with the appeal outcome by 4/9/2023.  As this timeframe is past the ten day turn around time  for the BBB response, I would like to ask that the family wait to hear the appeal response.  If the decision is not favorable, then in the appeal response, the family will be provided further appeal rights.  Thank you.

• Initial Complaint

  Date:01/29/2023

  Type:Product 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 insurance plan runs from Oct 1, 2021 until Sept 30, 2022 Moda Health ID# ********** Group#******** My Max Out of Pocket for this year was $2,850 AFTER I paid my $400 deductible, I paid various Drs, facilities, etc a total $4331.83 (and an additional $10 to keep accounts in good standing since they are still asking for payments)The difference, in which I overpaid, was $1491.83.I should be receiving a refund in this amount.Details......I had 2 surgeries this year, both at *****************************.***************************** is out of network, but bills as in-network.****** from this center concurs and agrees that my surgery was supposed to be billed as in-network.Both my surgeons, ********************************************* and ***************************** assured me prior to my surgeries that all would be billed as in-network and I would not have additional out of pocket charges.Had I known of additional charges, I could have delayed my surgery until there was an in-network date available.I have emailed Moda Health about this situation both in November and January asking them to contact me. I have shared with them this spreadsheet I am enclosing here, and imploring that they contact me to resolve this issue. I have not heard back from Moda, even after I mentioned I would be contacting the Better Business Bureau.***************************** (account #*******) continues to bill me for $118.91 Oregon ******************** (case #********) continues to bill me for $97.51 Thank you for your help in this matter.Sincerely,***********************

  Business Response

  Date: 02/08/2023

  Thank you.  

  Customer Answer

  Date: 02/10/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***********************

• Initial Complaint

  Date:01/19/2023

  Type:Customer Service 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.

  Moda health is my health insurance provider via Healthcare marketplace. I am using 471.63$ per month of premium tax credit. However, they charged me a full premium amount of 474$. I have contacted the government healthcare marketplace and they have confirmed me that I am eligible for an advance premium credit of up to 509$ per month. Despite my attempts to contact **** multiple times, they have not resolved the issue. I have not heard from them for 8 days since I contacted them for the second time to send documents provided by the government healthcare marketplace. I have attached my Explanation of Benefit, a screenshot from my logged into government healthcare marketplace as well as a screenshot showing the amount they withdrawed for your reference.

  Business Response

  Date: 01/30/2023

  Thank you.

  Customer Answer

  Date: 01/31/2023

   
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. However, as of today I still have not received the refund. I will follow up with you should they fail to follow through with what they proposed as a resolution.
  
  Sincerely,
  
  ********************

  Customer Answer

  Date: 02/06/2023

  This is a follow-up complaint for the ** ********. This business has not followed through with what they promised as of today on Feb 6, 2023. I have not received a refund promised and they have further charged me a full premium amount despite having said that the amount will be adjusted due to the Premium Tax Credit. I have been contacting them the past three weeks and no resolution has been achieved.

  Business Response

  Date: 02/07/2023

  Thank you for reaching out.  We have **** business days to process the refund.  This is what was stated in our response dated 1/30/2023.  
  
  This member should give us until Monday,  February 13, 2023 to process the refund.  Thank you.  

  Customer Answer

  Date: 02/07/2023

  Although you stated in your response letter dated Jan 30 that the Premium tax credit has been applied to my monthly premium amount, I was still fully charged for the month of February. Your letter does not state that I would be receiving a refund for the discrepancy for the month of February, it only says January. In addition, your attached invoice makes absolutely zero sense. First you show I have the premium tax credit of 943.26$, but then the amount due says ******. You need to write me an itemized list or refund you will actually issue instead of creating a convoluted invoice that makes no sense. 
  Sincerely,
  
  ********************

  Business Response

  Date: 02/17/2023

  We sent this matter back to the billing and eligibility department for investigation. You are correct, your EFT was pulled on 2/1/23 in the amount of $474.00.  This has been corrected and the premium refund is currently being processed. Please allow **** business days for this to be processed.  we apologize for any inconvenience this may have caused you.

  Records indicate that you were issued a refund for the January 2023 premium on February 8, 2023.

  We enclosed  an itemized receipt highlighting the funds received and also the refunds and their status.

  Thank you.

  Customer Answer

  Date: 03/08/2023

  Dear BBB, 
  
  
  
  I am writing this in regard to complaint 19340804. 
  
  
  
  I still have not received the promised refund from the business. Instead, they are using the money they owe for my monthly premium balance. Since they owe me something like 470$ and the monthly premium is less than 3$, obviously this will take hundreds of weeks for the money they owe to be used up. Either way, I have never agreed to this method of payment and they have agreed to issue a full refund. 
  
  
  
  I will have to ask you to yet again reopen this case since they repeatedly break the promise of what they would do. 
  
  
  
  Thank you, 
  
  ************;

  Business Response

  Date: 03/14/2023

  We contacted the billing and eligibility unit about this.  On 2/7/2023 you were refunded $471.63 as an ACH to your account.  The other refund is being sent for processing today in the amount of $466.89, this will also be refunded into your account within 7 to 10 business days.  I apologize for the inconvenience that this may cause.  Thank you.  Moda Health 

   

  Customer Answer

  Date: 03/21/2023

   
  Complaint: 18856645
  
  I am rejecting this response because:

  You have already said the exact thing in the previous response without actually following through. 
  
  Sincerely,
  
  ********************

  Customer Answer

  Date: 03/29/2023

  I can confirm that I have not received the promised refund today, on March 29, 2023. 

   

  Thank you 

  ************;

  Customer Answer

  Date: 04/04/2023

  Dear BBB, 
  
  I just wanted to let you know that I have received the check from Moda with the amount promised in mail yesterday. Could you please update the case to resolved for now? 
  
  Thank you very much for all your help,
  ************;