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I paid through marketplace and they barely covered primary care or podiatrist or ER visit. I had to report them to department of Banking and Insurance and barely amended. They receive tax credits and money, and should have covered. I will report again to Dept. Of Insurance and Banking.
I've had AmeriHealth for several years now, without a problem, but I never had any issues. I had a biopsy done for skin cancer when it came back positive. I called the company and explained that I needed to have a MOHS procedure done and wanted to make sure it was covered and the doctor was in their network. I was told yes, he was and yes, I was covered and it was just a $75 copay. I wrote the name of the girl, I spoke with, the date, the time. They refused to pay it saying at first that it was done at a surgery center (which it was not) it was done in the doctor's office.
I explained all that, gave them the date, time and person I spoke with and told them to listen to the recording of the call. They got back to me and said that the person I spoke with was from "Accolade" and they no longer use that company. They did listen to the recording and said the girl thought I was having another biopsy, which is ridiculous! Why would I need another biopsy if the first one came back positive? They still refused to pay it and today I will call them and I am requesting a copy of the recorded call to give to my attorney. I am livid. They are fine until you need to have a procedure done. They have no problem accepting your monthly payment.
This is the worse insurance company anyone could chose, including myself. I was hospitalized for 3 days and they are not covering services! In the hospital! All of my medications (I am a type 1 diabetic) are not covered by this insurance AT ALL. Customer service is a JOKE, just horrible.
Too funny these people...after speaking with them they confirmed that my additional (scheduled) payment that was received for December would be refunded to me due to Accolade billing nightmares/payment processing and overall deplorable customer service; today I receive an invoice of negative (1) month premium again.
I certainly hope that they did not realize that they screwed up again and decided to re-instate me because I specifically told them to send my (on time) December payment back to me - I want nothing to do with Amerihealth and/or Accolade, I want my money back and if I kept a running call time (on average you are on hold for at least an hour, then another half hour to speak with someone that has half a clue to navigate their total b.s. system) I would say that I have easily 3 hrs. each month of my wasted time X 9 months = 27 hours (which is light and very generous, I am sure) at my time that I value at $250.00 per hour = $6,750.00. Waiting for my premium back and will be on the phone with them for another hour + tomorrow so add $250.00.
Where to begin is really all I can say without writing a book. From day 1 choosing to have coverage with this company was the worst decision I ever made. Besides the worst customer service I have ever experienced, they have an outside billing company called Accolade; this company has no clue what is going on. Every month my payment was submitted prior to due dates, I would then get an invoice/bill that stated I owed (1) month payment... A few days later I would receive an invoice stating negative balance; no payment due... Another few days, get another stating that I owed (1) month.
Every month... literally every month that I received an invoice I would be on the phone waiting for an hour to straighten out Accolade... Ridiculous and they should all be locked up - they ended up canceling my policy due to non-payment; but they sent my payment back to me... How no payment when you sent me money back? FOOL ME ONCE, KARMA IS A ** AND YOU WILL GET YOURS... CORPORATE GREEDY **!
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I was hospitalized with a fractured vertebrae on Memorial Day weekend. The Orthopedic Group that saw me in the hospital doesn't take my insurance local value network. I went home in a back brace and thank god my daughter was here to help me find another orthopedic. She was on the phone with the 3rd party provider accolade for over an hour and on a another line calling the doctors they were saying accepted this plan. Most of them did not. Since then I have been referred by my Primary Care Physician to an Ear Nose and Throat Doctor who take some AmeriHealth plans but not mine.
Today I attempted to get on their website and it wouldn't load. I am waiting on line for a callback. This plan doesn't accept any out of network doctor unless it's the emergency room. I pay 655.00 a month for a plan almost no one in my area accepts. So here I sit in a back brace waiting for accolade to call me back and give me more names of doctors that aren't in the network. I live in Monmouth County NJ and I am sure they will try and send me out of state in a back brace.
Unfortunately, I chose AmeriHealth for 2018 because the monthly premium was $100 less per month than Horizon BC/BS. What a mistake. I have never had such a bad experience with any company in my life and as this is regarding my healthcare, it is important. A few examples: On hold yesterday for 45 minutes and never got anyone to pick up, had a question on coverage, they outsource Customer Service, despite having autopay from my bank, I've received letters that I'm not covered for non-payment.
Not all the routine blood tests done with my annual preventative exam were covered. I was surprised when I got a bill for lab work, as was my Primary Care Physician. Other preventative tests normally done (and paid by Horizon BC/BS) were not done because my MD knew Amerihealth would not pay. Their negotiated contract rates with providers are terrible. I paid $74 for an ultrasound last year with Horizon; with Amerihealth I have to pay $219 for the SAME test. What a mistake to select this provider. They should NOT be permitted to operate in NJ (or anywhere). Another 5 months, 3 weeks. Can't wait for open enrollment. Warning: DO NOT SELECT AMERIHEALTH.
Just to pay your bill you have to go through an outside vendor. It's been 4 days waiting for them to process my payment. I'm not sure if I have insurance or not, but I'm not going to wait 2 hours on the phone to talk to a moron. They raise rates every year and the coverage sucks.
This is my second year of having Amerihealth, and it is even worse than the first year. If you EVER have to call them for anything, make sure you set aside, I am not joking about 3 hours, because you will be on hold (With blasting circus music) for at least an hour and a half, and then you will be transferred around (probably hung up on accidentally) for the other hour and a half. The first year we had them, my wife went to the doctor twice, I didn't at all, the next year they raised our premiums by $100 and it still costs me $80 to go to the doctor. I called them to see if my plan covered vision (for close to $700/month for two healthy adults it should) and they kept sending me to a different department which hung up on me twice and I gave up and paid $300 for my glasses. Can't tell you to avoid them enough.
I've had this insurance for roughly 3 years now and I would give just about anything to switch to another company. I'm covered by them due to the Medicaid expansion under the ACA, which at first seemed like a blessing, but this company is a literal circus. When I went to fill my prescription on Tuesday, I'm told that my prior authorization had run out so they were denying me until it went through (which almost always takes a week or more). They're currently breaking Pennsylvania law regarding prior authorization that the governor just recently implemented for Medicaid recipients. As of the signing of that law, insurance companies who are part of Medicaid cannot deny someone their medication as part of medication assisted recovery due to a prior authorization. AKA prior auths are now illegal for MAT.
When I tried to tell them that, I get the run around and some BS excuse that the call center employee just made up on the spot. My pharmacist even told them the same thing and they lied right to him, claiming my medication wasn't included in that law (and the law was made specifically for that kind of medication). I'm currently crippled with sciatica and 8 months pregnant and cannot go without this medication, this medication is life sustaining by some standards, but that doesn't seem to matter to these people. I was fortunately approved for a 5 day emergency supply of medication thanks to my wonderful pharmacist fighting for it, but the problem is, I can't get the rest of my meds until Sunday, when my pharmacy is closed. So they tried to put it through for Saturday, and of course they won't even approve that.
So now I need to make two extra trips to the pharmacy or go without my medication for a day and a half thanks to their asinine prior authorization policy WHICH IS ILLEGAL. I always thought the prior authorization requirement was stupid to begin with... obviously the doctor already approved it and thinks I need it, otherwise he wouldn't have written the script. Why do they need the doctor to repeat themselves to prove that I require this treatment? It's clearly a ploy to get people to get frustrated and give up so they don't have to pay for my treatment, but I'm not giving up and I am reporting them to anyone I possibly can. I've had other issues in the past with them not wanting to cover my birth control (this was prior to the ACA).
About a year ago I get a letter from them stating that my medication was no longer covered because the doctor was located outside my home county and that I needed to find a doctor within that county. The problem is there are no doctors in that field in my county. When I told them that, they basically called me a liar and said "oh there has to be at least one in your county"... but there isn't.
So they finally approved another doctor... who's over an hour away (as opposed to the doctor 30 minutes away that I was seeing). After I finally leave my old doctor and get in with the new one, I get another letter telling me to disregard the first one, that I could keep my old doctor. Best believe I called these people screaming like a lunatic. They made me fight for weeks, making dozens of phone calls daily, sitting on hold and losing my mind all for nothing. This company is a joke and if you have the option to go elsewhere for insurance, do it. You'll get nothing but a headache from Amerihealth.
When dealing with the always impossible to talk with Accolade, eventually when you get through ask for the extension number of that individual so bypass the unacceptable time spent on hold. The obstacles put between you and the best treatment are solely financial and with these incredible hold times mean participants give up trying, just what they hope for. I cannot recommend a different provider but this is without doubt the worse experience I have encountered at any healthcare provider. My recent disappointment was turning up on a specialist referral, paying copay, waiting to see doctor to be told I was required to first try 3 different treatments - topical creams - and wait nearly 5 months before I could reapply for the medically proven best solution for my issue. It is not life threatening but why am I paying premiums to not get my specialists recommended course of action.
Stay away! Far away from this company!! The customer service is the worst of any company I've ever dealt with!! Trying to call their support team at ACCOLADE, is a LITERAL "WASTE OF TIME". You will sit on the phone for hours, then when someone answers and takes ALL your info, will transfer you to a voicemail that will NEVER call you back!! Or, will simply transfer you back into the queue where you will wait for another 30-45 minutes!!! Ridiculous!!!! I've called them several times over the last year and the result is the same!! I am moving my insurance to Horizon or Blue Shield ASAP!!!
Amerihealth Insurance is the worst medical insurance I have ever had. I have been with Blue Cross Blue Shield of NJ for many years and never had a claim processing issue. With Amerihealth, it is a nightmare!!! Examples: 1. I am told to go to Lab Corp for routine blood work. I did, over a month ago, and they processed it as a Tier 2 facility and I am told to pay the bill ($497.00+). I called Amerihealth and they stated they will reprocess. Sure they will, I received an EOB stating Denied. Now I have to deal with Lab Corp with a credit card and Amerihealth who still has not paid the claim.
2. I had a medical emergency, but instead of going to a hospital 6 miles away, (of course Amerihealth doesn't cover this facility), my wife drives me 40 miles to a Tier One hospital. I end up with the bill because Amerihealth states I had a Tier Two doctor look at me. First of all, I am in the ER and have very little to no choice of picking who the doctor is or was going to be. So, I am stuck with the bill even though my wife drove 40 miles to a Tier One facility. As of this review, Amerihealth has not taken care of the issue or paid this bill.
3. My local doctors are no longer Tier One doctors according to Amerihealth. So, I find a Tier One doctor, specialist, 40 miles away. My wife drives me to the doctor, very good doctor, but I receive a bill because Amerihealth codes him as Tier Two even though their website states Tier One. As of this review, that has not be taken care of or paid by Amerihealth. I worked in the insurance industry for over 22 years and as an officer of the company, this would never have been tolerated. Amerihealth on the other hand, doesn't seem to care.
Amerihealth is flat out horrible! I am constantly fighting to get the medication I need to be semi normal, but cannot ever seem to get it! I have been trying to get MRIs to figure out my horrible 5x a week migraines, but they won't approve my MRIs! After trial and error on some 15 different medications for my anxiety, my doctor finally nailed it. Can I get it??? No! Unreal! I will be researching how to take this further. Because of amerihealth's constant denials, I am not able to maintain basic day to day life without difficulty, or prove my health issues in order to get relief! And the real crap of the story is I see people every day getting the prescriptions they don't need so they can sell them for street drugs! The real people in need suffer!
I've been attempting to call this company on the daily to terminate my membership with them. CONSTANTLY having to wait for someone to call back, also they called back saying there's no representatives available!! Then when we finally get someone he says too bad since we never talked to a rep??? What! It's been days!! Another issue is they kept messing up our billing created us two accounts and said we owed 1800 OVERDUE!!! WE PAY EVERY MONTH! And called about this issue 5 times. If you're looking for a health insurance company DO NOT CHOOSE THIS ONE! I request my membership terminated 4/1/18 SINCE I'VE BEEN CALLING SINCE THEN TO CANCEL IT!
Being on Disability with Medicaid I have been with AmeriHealth for only one month. After getting a prior auth that was required, the medicine that controls my learning disability was "Denied Completely" and regarded "new" and "unnecessary". I had to borrow money to buy it outright. (I have been on this same medication for over 5 years and it has helped with my mental illness considerably) When I called AmeriHealth the rep told me that I was not supposed to fill my medicine until it was resubmitted for approval; and should I run out, to go to the Emergency Room! ABSURD! The NEXT DAY an APPROVAL arrived! I called to confirm this and was told that the pharmacy would reimburse me. 3 weeks later, NOTHING. Another phone call. Another rep said I must request my reimbursement in writing to PerformRx.
I went for my second refill that was due on March 9. The pharmacist told me that they won't authorize it because I was supposed to refill it exactly 30 days after receiving their "official approval". I was in danger of being without my medicine for days. Again, I paid $70 in cash. I have turned this over to the Attorney General. 2 facts cannot be disputed: 1. My refill schedule cannot be toyed with by an insurance company. THEY HAVE NO JURISDICTION and are blatantly DISCREDITING MY DOCTOR. 2. By forcing me to be abruptly cut from my health-sustaining medication with NO REGARD that not taking my medication "As prescribed" is DRUG ABUSE. They have overstepped their boundaries and must be held accountable. My requests for reimbursements are still being ignored.
I have been trying for ONE WEEK to terminate my health coverage with this company which I got through the marketplace. THANK GOD I am now getting coverage through my company. Absolutely NO ONE answers the phone. You will get caught in the "loop from hell" and never be able to reach anyone. I have even tried e-mail to no avail. I hope Amerihealth reads this message because now it's the only one they're getting from me. Please terminate my policy as of 4/1/18. You will receive no further payments from me. When I receive the notice that I've been terminated due to non-payment I will laugh and throw it away YOU MORONS!
I have been a customer with Amerihealth for over 10 years and will never be a customer of theirs again. My coverage was canceled due to late payment, however, I received no notification of termination and continued to receive invoices from them and they continued to deposit my checks for months following. They claimed they "issued a refund" when in reality they held on to over $4,000 worth of checks before I had to finally request that they send me my money back. When I asked why I never received a clear notification of termination, they claim that they are not required to notify their customers of termination or of termination dates. NOT REQUIRED TO NOTIFY THEIR CUSTOMERS OF TERMINATION??? Let that one sink in a minute.
However, upon further investigation it clearly states in their member's rights section that members "have the right to prompt notification of termination or changes in benefits". Amerihealth clearly violates their own stated policies. What kind of company can just cancel someone's coverage without being required to clearly notify them of when and why and leave them without health coverage or any way to reinstate said health coverage!? These are people's lives they're dealing with not just some small insignificant thing. This company should be more than ashamed of themselves and their backward ideas on how to treat their consumers. I will never use or recommend this company to anyone ever again. Disgraceful.
Looking through so many of the reviews on here, I see I'm not alone. I enrolled in Amerihealth in 2015 through the Medicaid extension under the ACA, in Pennsylvania. In June of 2016 I had a cyst removed from my neck. I was told by the staff at the doctor's office that my insurance company had approved the procedure. I also had a blood test and a chest X-ray. No one at the hospital ever questioned my insurance or asked for any kind of payment. Then about six months later I get a bill for $24,000, then a bunch of other bills totaling about $10,000.
I called the company several times and kept getting a run-around. Then I went to the county assistance office and was assigned a caseworker who looked into it and found out that somewhere along the way, the wrong SSN had been entered. So everything was sent to Harrisburg to be resolved. After about a month the caseworker informed me that everything was straightened out. But my relief was to be short-lived. I'm still getting bills and calls from collection agencies. Calling Amerihealth is, of course, fruitless.
Amerihealth is horrible. Their customer service is unreachable. They don't answer the phone. My son is in college out of state so I have to sign up for guest advantage program, but they do not have any Doctors that take Ameri Health who are taking new patients. They don't pay bills. It is sad that this company has the name Ameri in it. I guess they're all the same, more money less coverage. All they care about is the dollar and not the people. I would leave zeros on all of these stars if it was possible but they are making me give them 1 star.
Thousands of pages of documentation deliver a very clear story that AmeriHealth is a company which is set up to fail at their job of reimbursing their members for health services. Just about every single healthcare transaction has had some sort of problem, from delayed payment which leads to the subscriber being taken to collections, to the seemingly random denial to pay claims which have been successfully processed in the past, to the misdirection of reimbursements time and time again to the wrong parties. All of this seems to lead to the premeditated act of paying as little as possible and taking as much time to resolve the issues as is possible. We now have a Senior Account Executive, promising to look over every single claim of ours before it is finalized to be sure there are no problems. Problems have continued, regardless. Some of the main issues we have had since we started with AmeriHealth in February 2015:
Failure to reimburse out of network claims for many, many months at a time, at one point leading to over $9,000 in out of pocket costs. Sending payment to the wrong party time and time again and a vast variety of claims, thus delaying reimbursement of the proper party while everything gets resubmitted. Failure to work out a billing issue to the point that we were taken to collections for the bill, which should have been covered from the start. Failure to pay in network doctors and acupuncturist for months on end, due to a variety of issues, leading to uncomfortable discussions with providers who start to ask me to cover their costs until AmeriHealth can get their act together. Hours upon hours of lost productivity as I follow up with every single claim that has an issue.
I'm seeing a lot of negative comments which made me want to make an account. I LOVE AmeriHealth. I literally pays for everything! At least for me. I see a couple of specialist and they pay for them. Any medical test they have paid. The only thing that they did not pay for was botox on my bladder because they said I was too young and they wanted me to have other options to see if that would help. I recently found out that they pay for gyms. Two where I am at. Sometimes the doctors will prescribe me something that's almost $400 and they pay for it. The only thing that they stopped paying for was this medication that was almost $400 because I think it was out of their list that of treatmemt medication that they pay for but I'm working on that one. I did get the resolved and they will pay for it now. Otherwise I have NOTHING to complain about AmeriHealth. But a lot of people are different and have had problems with them I don't know why. Highly recommended it.
Amerihealth NJ continues to send my husband invoices even though we never enrolled In Amerihealth, no longer live in New Jersey, and we have been enrolled in another plan (Oscar) from Day 1. That doesn't stop Amerihealth NJ from sending us invoices for hundreds of dollars 'past due.' This company is a scam and should be closed by the government. I don't understand how it is allowed to operate. I fear that confused consumers might think this is a legitimate business and be forced to pay these fake invoices.
I called Amerihealth yesterday regarding a letter I received dated 12/6/16 from them informing my subsidy credit was reevaluated for more $ for my plan I chose for the year 2017. My invoice that went up considerably from my 2016 plan did not reflect the reevaluation amount (credit). I was told it was not from them (Amerihealth) and they do not reevaluate and a third party call was patched in with the market place that also denied sending it. It was from Amerihealth signed by the CEO. Does the right and left hand know what it is doing at Amerihealth?? I didn't send the letter to myself! I am taking my complaint to my local Senator's office!
My claims have been unpaid for over a year. I want to tell everyone to write a letter to the Commissioner of Insurance in your state. They will take action. I was reimbursed 2 months after I provided proof of my claims.
The absolute worst customer service. I had claims from December 2015 they denied saying my policy had been cancelled. Initially when I called they verified my policy was never cancelled. I was told the claims would be sent back to the claims department. I have been calling them for 5 months now. Every time I called and was told the situation would be taken care of, the person made a mistake and I had to start all over. Spoke today to yet another supervisor who said she would contact the claims department and follow up with them. I also filed a complaint with her. If this is not resolved I will file a claim with the NJ Dept. of insurance. Stay away from Amerihealth!!!
Was told renewal plan was same as other. Go to ER. Suddenly instead of $100 copay it's 1500 in network (NEVER TOLD) then I get a $600 facility charge for in network hospital. ER doctor sends bill for $602. I had no choice in who I got. I am told one thing by one person, then another by another. This began in January and I have been jerked around and keep getting conflicting answers. They now have a company called Accolade to "help". It's just more jerking around. No clear answers. They have no responsibility to me as the person who pays them, no one looks out for the insured and their incorrect information and bs has wasted hours of my life. I do not trust them anymore. They take my $$ and do nothing. It is disgusting. HATE THIS PLACE WITH A BURNING PASSION!
I was an unlucky owner of Amerihealth insurance for 2 years. I was at the doctor maybe 5 times, and had problem with 3 payments. They didn't want to pay for the PCP visits, all the time they see some problems with the doctors, or they were unable to change my name in the system for 1.5 year! After spending a huge amount of time, they did it. Then I change the insurer.
Stay away!!! Terrible customer service! Insanely rude! They will flat out lie to you and fight with you on the phone. Signed up for a policy via healthcare.gov. The policy did not match what they displayed on their website. Which means they showed I was covered for services I was not. Each time I called Amerihealth, I would get a completely different story. At one point, the CSR told me I have no coverage (couldn't even visit a hospital) if I was outside of the service area.
Finally, a CSR (confirmed with the supervisor) told me that I could visit a doctor that would be covered under my medical plan. They gave me the address and name of the doctor I could visit. I make and attend the appointment. THE CLAIM GETS REJECTED. They told me the info that is listed on my medical cards AND the policy on the Amerihealth website under my login is not correct. They also said the rep was incorrect for giving me the information and they refuse to pay the claim. To top it off, I was told it's MY fault for not knowing if the doctor would be covered under medical. They said I should have known that the info was incorrect on the website and my medical cards. Please stay away from this company. The CSRs are terribly rude and will yell at you.
I am part of the Amerihealth NJ Regional Preferred Network. I pay upwards of $2,200.00 per month for out-of-network services. On top of my premiums, I have paid my providers $20,000 out of pocket. After my deductible is met, I should receive approximately $12,000 back from Amerihealth. To date, they have only reimbursed me $4,000. My son has autistic spectrum disorder and he see therapists three times per week. I have claims for my son's services dating back to July that have not been reimbursed yet. On one claim alone I have called 4 times still with no resolution. Randomly dates-of-services (DOS) are left off claims. Some are paid and then some are noted as being applied to my deductible even though the deductible is met.
I have been given the excuse that I am seeing an out-of-state provider when the provider was and still is in NJ. I've been told my claim was marked as seeing an international provider. I haven't traveled outside the country in years. I was also told I wasn't supplying the PROVIDER ID CODE. What's that? After further questioning of the customer service rep I found out that is an internal code to Amerihealth. How would I even have the number, but in an effort to get my claims processed I got all the PROVIDER ID CODE numbers for family's providers and mark each and every invoice with that number. That hasn't worked either. I am at a loss of what to do. I call the reps, they can't answer my questions, they send my claim back for review (that takes 30 to 60 days to process) and then I get an Explanation of Benefits (EOB) with the same response (denied).
I just called for the third time today regarding my own doctor bills that keep getting denied with the Remark Codes on my EOB indicating I don't have out-of-network benefits and I haven't met my deductible. Both statements are untrue. I got a less than helpful customer service rep who had an attitude and told me all she can do is submit it again. I asked her how is this going to be different than the last three times I submitted these bills and she couldn't answer me. So, I suspect in 30-60 days I will be calling them again. These are just a few examples of the issues I am having. I feel like I am trapped in a black hole with no end in sight. How am I suppose to get my reimbursement when all I get is excuse after excuse. Amerihealth is by far the WORST health insurance I have ever had.
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