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:01/19/2023

  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.

  Applied for insurance through the health exchange in Nov and was excepted Nov 7 for the **** premium from moda health starting on Jan 1st. Dec 22nd I checked moda insurance dashboard they have a 490. Charge not the 2 agreed upon. I called the exchange they said I'm insured for **** called moda back they said not on file. I have been calling and checking the dashboard every three days and can't get it resolved. We even did a four way call to get it fixed with the guy who did the application moda and the exchange and myself and moda still did not fix it. We called yesterday one person says it's a tech issue and a lot of people having same issue. In the mean time I have no med insurance and can't go to the ******** person just said go to the Dr but when I tried it shows no insurance. This is a big problem and they know about it but can't or won't fix it.

  Business Response

  Date: 01/26/2023

  Thank you.

• Initial Complaint

  Date:01/01/2023

  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 purchased Moda Health dental Insurance start at 1/1/2022. I have a treatment provided by New Smile on 11/22/22. Moda dental denied my claim and told me the reason for denial was listed as New Smile is out of the network, but the problem is I have never received my medical card and handbook, and I thought the insurance would cover a cleaning at any dental office for definitely as it is PPO. Until after the treatment, the dental office notified me the insurance wont cover the cost because it is exclusive. I did not receive member ID card and handbook, I have no way to know the rules. By the way, I received a denial letter from an appeal coordinator. In the letter she said my plan is EPO but when I review my policy it shows PPO. it is pretty unclear for us as a common consumer, and it caused a lot of confusion. I am not an insurance expert, and I have no way to know the difference between PPO and PPO exclusive because Ive NEVER received the card and the handbook! I also attached a pic to show you the second reason why I visited New Smile. I got misled by moda website. I logged into my account on the website and found New Smile on the network which shows on the map. When I spoke with the **************** manager, I noticed that I am not alone. There were many victims who got misled by the website map and by the exclusivePPO!

  Business Response

  Date: 01/06/2023

  Thank you.

  Customer Answer

  Date: 01/06/2023

   
  Complaint: 18668079
  
  I am rejecting this response because:

  I attached a screenshot which shows on your website. New smile office is on your map.  Many people got confused by that even New smile office manager said she was confused why her office was showed on YOUR website. Regardless what the detail shows, your website cause people confuse. on this point I think you need to take responsibility . 
  
  Sincerely,
  
  ***********************

  Business Response

  Date: 01/18/2023

  We reviewed the attachment provided by *************  We are unable to confirm how ************ located this information.  *********** with dental providers specifically not dental offices.  Also, a member must confirm the network accepted by the provider.  This screen shot from Findcare, that was provided, is not suggesting that *********************, DMD is contracted with the plan.  I attached a screen shot from Findcare indicating this as well.  ************ contacted Delta Dental on the date he received treatment and was advised that ************** was not a participating provider on his plan.  We are unable to process his claims.  Thank you.  

• Initial Complaint

  Date:11/22/2022

  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.

  Moda Health charged me for insurance coverage for the month of November 2022, when I cancelled the policy on 10/31/2022 via the Moda Health website. Also called on 10/31/2022 and was told by a representative that my cancellation would be routed to the proper department. On 11/3/2022, I called Moda Health again and spoke with someone who finished processing the request, and told me I should NOT be charged for November. My financial institution showed a charge for Moda Health and Moda Dental in November, thus I called back and was told that I would be receiving a refund, that my coverage ended 10/31/2022. Up to this point, I have still not received any notification from Moda Health, via email or regular mail, that my policy has been cancelled. I called again today, 11/22/2022, and was told that my coverage will end 11/30/2022. I asked for a supervisor or Lead to call me back. I received a call at 5:07pm from a Lead representative who told me that she found no telephone call from me on 10/31, and that there is no option to cancel coverage on the website. This is FALSE. Currently, the website says that my request to cancel is in process and my coverage is due to terminate 12/31/2022, therefore there is clearly a miscommunication between the website, the telephone service with Moda, and the representatives at Moda Health. Therefore, I am confident that my request was never received when I terminated the coverage on 10/31/2022, and yet I am still being charged/penalized. The Lead told me that I would not be receiving my refund, even though I was told that I WOULD be receiving my refund.

  Business Response

  Date: 11/30/2022

  Thank you.

• Initial Complaint

  Date:10/31/2022

  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.

  Oregon state laws states that when an employee is let go their final pay check is to be issued the end of day next business day. MODA Health refuses to abide by the law due to receiving a charge each time that they input for a direct deposit. They have stated that they understand the law but fail to follow it because of a fee charged by their bank.

  Business Response

  Date: 11/02/2022

  The Moda Health *************** (HR) Team was contacted about this matter. **************** was given the option of a check or direct deposit for her final paycheck. There were two HR staff present at the time of ******************** release and she indicated that direct deposit was her preferred option.  We weer not able to confirm ******************** consumer statement.  Thank you.

• Initial Complaint

  Date:10/25/2022

  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.

  This company is a SCAM!!THEY DON'T EXPLAIN ANYTHING TO YOU, THEY TRY AND SCAM AND PLAY THE SHE'LL GAME I WAS TRYING TO MAKE AN APPOINTMENT FOR A PROCEDURE THAT IS PREVENTATIVE I CALL MODA TODAY AND WAS TOLD THE PROCEDURE IS AT NO CHARGE AS LONG AS YOU HAVE NOTHING WRONG. OTHERWISE IT TURNS IN.TO A MEDI CLAIM AND I WILL BE CHARGED $300!!WHEN YOU DO CALL YOU GET AN ANSWER THAT ISN'T TRUE.ALL OF THE *** WILL TELL YOU A COMPLETELY DIFFERENT ANSWER I'M AFRAID TO SEEK MEDICAL ATTENTION NOW THAT'S NOT RIGHT!!!GRADE F FOR TAKING CARE OF US ALL ON ******** YOUR COMPANY REALLY DOESN'T GIVE A **** ABOUT THE CUSTOMER!!!!!

  Business Response

  Date: 11/04/2022

  Please see the attached letter.  Thank you.

• Initial Complaint

  Date:10/06/2022

  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.

  MODA Health August 2 (automatic payment) premium of $244 didn't clear (my fault) - but I received an email from MODA on Aug 3 saying that they received my payment. (Your payment confirmation number is: ODSINS002698605). Not knowing, the payment didn't go through, I did nothing. Then I was assessed a $25 late fee for August when my September 2 payment was processed. I thought the Sept 2 payment was for September premium, but it was for August since the August payment didn't go through (unbeknownst to me). On Sept 27 I called to make the make-up payment since I could see on my bank acct that the August payment never went through (Call ref# ************). I gave the representative the same routing and bank account numbers to make the extra payment. She said I was caught up and my Oct payment would go through as scheduled. Oct 6 - find out insurance cancelled through pharmacy during pick up of prescription. Called MODA (Call ref# ************) and was told Sept payment didn't go through (my account DID have sufficient funds) so my daughter's insurance cancelled. I gave banking info again during this call and was assessed a late fee AGAIN even though I tried to pay in September. Now, my daughter (**************) has no insurance, was told it will be days before I will find out if she is reinstated and was charged a late fee when I attempted to pay on time.WHAT I WANT:Refund of 2 late fees (2 X $25 = $50) assessed erroneously.Reinstatement of health care coverage.

  Business Response

  Date: 10/07/2022

  We need a member identification number.  We do not offer plans in **********, and the address of this person is in **********.  Tried to look the member up by the name and no luck.  Thank you.

  Customer Answer

  Date: 10/07/2022

   
  Complaint: 18177823
  
  I am rejecting this response because:
  

  I included the personal information in the attachment.  The BBB email says to not include this info in the email since it may be displayed publicly.  I am writing for my daughter who I  bought the policy for.
  Sincerely,
  
  *******************

  Business Response

  Date: 10/24/2022

  The payment for the two outstanding payments and an additional payment in the amount of $244.00 for **************** November premium payment for a total of $732.00 must be paid in full within 30 days of the date of this letter.  Thank you.

• Initial Complaint

  Date:07/28/2022

  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 enrolled in Marketplace 2-22and made a poor choice Moda health . The customer ********************** is decent and they are always polite...that's as far as it goes! I was approved for and had total hip replacement on july 18 2022. My prior experience with moda alerted me that I should call prior to the surgery to talk about aftercare. It is a back and forth with the customer ********************** about in network providers. Even if thgey are on the list of innetwork it does not mean the provider will see you. Many of the providers say we have never heard of Moda. A case worker that works for moda told me moda did not take the time to develop the relation with providers and therefore there is no trust that bills will be paid. I was approved for pt with ************ in ********** *****. I had an eval before and after the surgery. Following the second appointment on **** the owner/pt called me and said the **** he submitted was rejected by moda and american specialty health (their associate) Dr. ****** said for my protection he would not see me until this billing was resolved. I had to once again call moda to resolve an issue that I should not have to deal with. I am trying to recover from hip replacement surgery and find myself on the phone hours a day. My frustration is coming through and they have nothing to say If I ask to speak to a supervisor I get put on an endless hold. To say they are GARBAGE would give them too much credit. They expect a patient to lay at home and heal them self following a major surgery which to me is insane I'm really not sure what else to say. I have filed a complaint with ***** **** of insurance as well. I hope someone else does not have to go through this nightmare

  Business Response

  Date: 08/01/2022

  We have received this same complaint from the ***** ****************** and due to the fact that there are a few issues that need addressing, we will respond to your office by Friday, August 12, 2022.  We can tell you that Moda Health has been in contact with the member to assist him.

  Thank you. 

  *********************, Appeal Supervisor for Moda Health

  Customer Answer

  Date: 08/02/2022

   
  Complaint: 17640709
  
  I am rejecting this response because: Time was/is of the essence after a major surgery . I had called many times before the surgery to try to make sure I would get the care I needed to be able to recover properly. I was met with the same response being there are very few providers in the area. It turns out there are several Home health companies including Cristus, Central ***** HH,St. ***************** the problem being none of them trust that they will be paid for services rendered. The case in point was My July 25 appointment with limitless PT for eval the next day the owner/PT ******************************* called me to say they would have to d/c services to me because payment was rejected. I the person lying in bed in writhing pain has to get on the phone with moda to try and sort out a billing issue. The moda rep said she would resubmit for payment. In the meantime the days go by with no help to me. The PT appointment they rejected was approved in may for apx 10 visits. Mr. ********** said to me The PT would be more effective after the surgery. That is why there was only the single visit....IT WAS A MODA APPROVED VISIT! When I call their CS at moda and ask to speak to a supervisor they state I will get a call back ***** hours but that never happened.  Anyone that listens to the 20 or so calls I was forced to make will hear the sheer inability for moda to make services for me happen. I will not say the entire company. ********************* has been my only lifeline. Without her It would be a big fat ZERO.
  
  Sincerely,
  
  *************************

  Business Response

  Date: 08/15/2022

  Thank you.  

  Customer Answer

  Date: 08/15/2022

   
  Complaint: 17640709
  
  I am rejecting this response because: The number and time I have spent on the phone with Moda reps in the time since enrolling in the system can only be ascertained by review of phone records. I estimate 45 hours. Much of this time was an exercise in futility. Being polite and actually assisting the customer are two very different issues. *********************** is the only Moda employee that made a difference. It is through her hard work and fortitude I was able to get post surgery care. The issue I have is that the care post surgery should have happened July 19 or the 20th at the latest. Instead while I am suffering the pain of a major surgery I am also suffering the psychological torture of having no aftercare. Take the time and listen to all the calls coming from ************ between 7-1 and 8-5-22 and explain to me why and how this exception with Ranier took so long. The post surgery care is time sensitive and Moda seems to have ignored this fact
  
  Sincerely,
  
  *************************