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Business Profile

Insurance Companies

The Health Plan

This business is NOT BBB Accredited.

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Complaints

Customer Complaints Summary

  • 2 total complaints in the last 3 years.
  • 1 complaint 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.

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Complaint type

  • Initial Complaint

    Date:02/24/2023

    Type:Billing Issues
    Status:
    Answered
    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 had health insurance with TheHealthPlan from my employer between Jan 1, 2022 until Jul 31, 2022 (when it terminated by my company citing I didn't work the required number of hours as I had taken Bereavement leave of more days than is allowed by the company rules). I had get a Stress TreadMill test per my Cardiologist in Feb 2022 and I provided TheHealthPlan insurance when I went to the appointment. I had a deductible of $1000 and already called *** a few times, to find what the cost was, with insurance and without. *** told me without insurance it would be $1250. However, when the bill came they didn't bill the insurance and billed me about $2500. This in May 2022 and I put TheHealthPlan customer service agent and the *** billing agent on conference and *** finally said, they had the correct number.

    *** did not even do a full stress test, as my Blood Pressure was very high before I started the treadmill (175/100) and the nurse said she went and checked with a doctor and the doctor ok-ed the test. I, however, was asked to stop the treadmill test in under 1 min as my Blood Pressure shot up to 200/110 from what I saw. *** then simply did an ultrasound and sent me my way. I don't understand why *** didn't send me back home when my BP was high to begin with so we could do this another day. $2500 for ultrasound was way too much. In the meantime in Jun 2022, TheHealthPlan rep called me and asked me to pay $676 (as a fair amount). I then proceeded to call *** Billing to pay the amount, however, *** wouldn't accept this amount and they said that I needed to call The HealthPlan and they never settled on $676.

    In August 2022, Kristi E****** got my case and wrote many emails until now saying they are working on this, however, nothing has been done. *** sent my case to collections I think and I am at a standstill. Please help resolve how much money I have to pay *** to resolve this case and remove my name from credit collections after I pay it.

    Business Response

    Date: 03/07/2023

    This letter is in response to Customer Concern Number ********* a concern submitted by ****** ******* to The Better Business Bureau regarding the member's liability on a claim from date of service 2/10/22. A copy of the concern and your letter are enclosed along with a timeline of the case with the Patient Advocacy Center at the employer group's repricing network.

    The member was covered under a self-funded employer-sponsored group health plan for which The Health Plan serves as a third-party administrator (****. The issue is with the repricing network for the member's employer group which is ***.

    Nonetheless, we have researched this concern and determined that The Health Plan reached out to *** (the group's repricing network) back on 8/25/22 and started a Patient Advocacy Center (PAC) case with *** on 8/26/22. The PAC had reached out to the member numerous times asking if the member would sign a Fair Credit letter which would allow them to manage her case and prevent credit impairment. The member refused to sign the letter. The member was also advised to send in the deductible amount of $676.33 to the hospital for a "payment in good faith". The member also refused to do this. Just as recently as 3/3/23, the PAC at *** emailed the Billing Service Supervisors at the hospital in question to negotiate a rate where the member is to be charged no more that the $676.33 which was applied to member l s deductible.

     

    Once the negotiation has been completed, the claim will be reprocessed here at The Health Plan. The member's employer group will pay any additional reimbursement per the *** negotiated rate and the member will be responsible for the initial amount which has been asked all along which is $676.33.

    If you have any further questions or need additional information, please contact me at ********************* or ************** , Ext. *****

    Manager of Appeals & Grievances

    ****** *****

    Enclosures

    Customer Answer

    Date: 03/07/2023

    Better Business Bureau:



    I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this proposed action would not resolve my complaint.  For your reference, details of the offer I reviewed appear below.


    I had already mentioned this in my original complaint, that *** will not accept $676 as payment from me as a patient. I had tried paying this amount by calling their Billing Department in Aug of last year. They said they never agreed to an amount of $676 with PAC in the first place. They asked me to go back to PAC about this which I immediately did. This matter has been in stalemate since. PAC had wrote to me every 3 weeks after Aug 2022 just hogwash me. They never really contacted *** back. In the meantime, *** sent my case to collections and the record of this Amount Due doesn't appear on MyChart*** online account. PAC have been sending me Fair Letter Credit since 2-3 months (they called it -- I have emailed you a HIPAA Release form to approve of this representation.) to sign to speak with *** on my behalf when that is what they had been doing since Aug and the case is already with Collections. I have all the emails of my correspondence and can send them to you if needed. I always insist on emails so I can keep a record. Please see below (this email is from Jan 10 this year and the case is already with Collections and they insist that I pay $676 when *** Billing will not accept this amount). They have done nothing in my case and only stalled me (the actual insurance since May 2022) and then PAC (I don't know why these guys came into this picture since Aug 2022). I am at a stalemate and won't sign any Documents. PAC can speak with *** without me signing any Documents, because they said they already spoke with them in Aug/Sep, therefore I don't understand what bind they are trying to put me in with a DocuSign document. This insurance has not paid a dime with my Medical Bills and if they don't help me, I need my complaint to stay on your BBB page for their Business so other self funded insurers know what they are getting into. 

    Thank you
    *******


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