Consumer Complaints and Reviews
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!!!
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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.
What an awful experience! They lied to me that my provider is on a tier 1 network and the copay will be $15. Now they claim they never told me that and that my provider is really tier 2 with a $50 copay. I've called them numerous times and they either hang up on me, or never return my call. What an awful company with the most awful customer service. Please save yourself the headache and do not use them!
This company operates like a criminal enterprise. They take your premiums and pay nothing. My claims have been processing for 3 months. They are still "in process." Every rep I talk to cannot even tell me why, literally! There's no rejection code. They sit there ignored. I have several claims and recently had surgery. It takes ages to get through to a rep and even longer to speak to a customer supervisor. Or you get put on hold for half hour or more. Emails go unanswered when sent through their customer portal. I was told someone would definitely call me back in 48 hours and guess what, nothing! They are a fraudulent company. Please do not do business with them.
AmeriHealth Insurance should, I repeat, should not be in business. Every facet of their operations, from customer service, to claims, approvals for imaging, to centers where a patient can go to be scanned or seen by a physician, you are harassed by someone in a letter of disapproval. They are the WORST HEALTH INSURANCE CO. I EVER ENCOUNTERED. I had to report them to the state on two occasions. Please if you have AmeriHealth, run to a different provider even if it costs more.
This is new insurance for me and I have not been able to do a provider search for the past 3 weeks. I call customer service who need a ton of info prior to talking to me to be told that the website happens to be down "today" and they can't help me. They don't know why and they can't control that. I'm paying a lot monthly for what exactly??
I had to pay for prescriptions even though I had reached my out of pocket maximum because Future Scripts computer was not talking to Amerihealth's Insurance. Almost a year later Future Scripts will not return my funds. I will be on Social Media and TV. I've been working on this for almost 8 months.
Please be advised: I was made to lay out payment for my wife's heart medication ($375.00) and was told I would be promptly reimbursed. That was on Nov. 11th, 2014... a full sixteen months later I have yet to be paid. Although I sent them proof several times I was, once again, told they did not receive the proof. This is just plain wrong.
This insurance company is one of the worst. Like others have said they are cashing my checks but telling me that my daughter had no health insurance. There was apparently one missing payment that I thought my bank had sent electronically. I explained that there's was some sort of error made a double payment & was told I'd be reinstated. Well I wasn't. Called again. Was told someone would call me back. Nope. I call now mind you. They are still cashing my checks & have over $600 of my money. They now deny reinstatement with no reasoning & it's 5 days past open enrollment.
This company needs to be investigated for fraud against the consumer. We have had a similar situation to one of the reviews listed. Amerihealth deducted 6000 from our account over the months and has not covered one medical expense. You cannot get one competent person on the phone to help you. I have four children. I had a child this past year, and all expenses were paid out of pocket because they kept promising to fix the situation and never did.
We went back and forth with the marketplace and our child under the assumption that since they were withdrawing money that our medical expenses were being covered. Not one pediatric bill was ever covered with this insurance. After fighting with inept people, after taking our money, they said we were dropped. No notice, nothing. They claimed that we were delinquent in one payment, that was never the case because we have the bank statements to prove that they withdrew our money. They are criminals! Now we are waiting for a new insurance company while my family has no coverage at the present moment. The rest will be handled by our lawyer.
Amerihealth took 7,000 of our $$ bank receipts shows our payment. Husband was informed at the hospital he was ineligible. Hours trying to figure out what the issue was. Tons of call to ins co. Not one supervisor ever returned my call. Finally reach supervisor bank statements show month payments over 2,000 a month paid and we were dropped as of 11.1.15 with any knowledge! I recently had 2 surgeries done one in December 15 and last week. Advised they will send info to reinstate could take up to 72 hours! Meanwhile 5 family members with medical issues no coverage yet. Amerihealth has my payments! Very upset!! Still no answers to where our $$ is!!!
I tried calling Amerihealth to discuss enrolling in them via the affordable care act. I was on hold for over 30 minutes and no one answered the phone. I will switch to United Healthcare.
The biggest problem I have had with Amerihealth happened back in July. On July 4th I was released from the hospital with 7 broken ribs and a broken wrist. I was in severe pain for weeks and on July 14th my Doctor wrote me a prescription for a stronger Fentanyl patch. My plan it turned out required prior authorization. The pharmacist faxed my Dr. the phone number to call at Amerihealth which they did and were told the necessary document would be faxed to them. By 4pm they had not received the document. I call customer service and was given a total runaround.
I explained that my Dr. needed the required form for the prior-authorization. I was asked a few questions and put on hold. When the representative came back on the phone she said they have no record of a prior-authorization being submitted so I explained again my Dr. needed the form. I was put on hold again and she came back with the same comment. This happened about three times. I hung up and went online to see if I could find the form, but I was not able to determine the correct one to use so I called again and got the same runaround. On this time it was worse. The representative put me on hold and when she came back she said she called my Dr.s office and asked them if they could go online and get the form themselves. They refused.
I asked the representative if they could fax or email the form to me and she had no idea how to do that or who to ask for help. By this time my Dr's office was closed and I was in too much pain to wait another day, so we paid for the prescription ourselves, it cost us $231.11. The complete incompetence of Amerihealth representatives in this matter is appalling. My first call to Amerihealth lasted 20 minutes and the second lasted 33 minutes.
I have attempted to contact them to make a change in the plan. When told to hold for a representative I was disconnected 5 times. Emails have been ignored. Perhaps because it is the time for open enrollment they are overwhelmed. Since I was completely unable to reach Americare NJ after repeated attempts I enrolled with AARP insurance United Healthcare and found them to be easily accessible, responsive and knowledgeable.
I have tried to get approved providers to go to and have consistently over many days and many efforts not been successful. This company is terrible and I will not be with them in 2016. I sure hope other insurance companies are better, although it would almost be impossible to be worse.
This is the worst company that I have ever dealt with. They changed my policy at the end of the year without my consent. Billed me a higher amount than they had quoted and then were unable to change the policy to that which I requested. I called every month since January to be left on hold for long periods of time without anyone seemingly interested in helping. The only thing they have been able to do consistently is bill me and threaten to cancel my policy if I didn't pay (even if they have billed me incorrectly for most of the year). I had asked to add an additional dental plan in January (and was paying for it) but for 6 months they have been unable to confirm what the plan was.
Many of my claims have been unpaid and each department sends me to another (sales, customer service, billing, Dental provider...). I finally managed to speak to a supervisor who sounded more helpful, explained that somehow they had registered me on 3 different accounts and promised to solve my issues... but subsequently never responded. I have sent her 3 emails since without reply. I have continued to pay extremely high monthly premiums for little to no benefit. They should not be able to treat customers in such a way without some sort of recourse for their actions. I would recommend using any other service provider.
I have an individual exchange plan with Amerihealth. Recently, they sent me a new ID card with a new account number with a letter that advised me to activate the card by phone and dispose of the old card which I did. I pay my premiums by direct debit but for some reason they did not debit my account for September. When I called customer service I was given the runaround. One rep told me that they had no record of my account. Another rep told me that they were changing to a "new system" and that I would have to re-register for premium debits or I might lose my insurance! I tried to re-register but was put on hold and eventually disconnected.
Their website was down and I could not pay my premium online or by phone. At no time was there any written communication to me that I had to re-register. Now I am worried that because I am not able to pay my premium I may not have health insurance and all because they are so poorly managed! Their communications to their customers is the worst of any health insurance carrier that I have ever used.
My wife has been taking a specific medication for nearly 10 years. Amerihealth declined to pay for it. The doctor sent in a prior authorization form and Amerihealth denied it again. The doctor knows my wife's situation and prescribed this medication knowing it would help her. Now, she has to live in fear that her chronic pain, heretofore managed, will come back.
If you are considering this company as a provider you are doing a disservice to your company and your personnel. They and you will be very unhappy and frustrated. It's not uncommon to be placed on hold for an hour when you call. Questions are rarely answered, they have to call you back. They never call you back. Their people do not understand the differences between family and individual deductibles. In fact, they know almost nothing about the plans and what they provide. It took two months to straighten out enrollments for our employees with FutureScripts and they have taken months to send out insurance cards for dependents. This is the most poorly operated insurance carrier we have had over my 40-year career. Worse yet, they have no interest in improving customer service or educating their personnel.
I have been diagnosed with a nodule and need a biopsy. Have called several listed doctors in my network and they are all telling me they have been in negotiation with Amerihealth for over a year of nonpayment to them and are not taking Amerihealth insurance. I have called Amerihealth and have been promised a call back from a Manager and never receive a callback. I keep trying everyday to contact them and after 30 to 40 min keep getting the runaround with no answers. I am extremely upset and need a biopsy and can't get a Dr. so my primary care doctor can write a referral. This is insane. Day 5 of this nonsense and still don't have any answers, nevertheless a return call. Please help. My health is in jeopardy!!!
So many things to list. But most recent my husband needs an MRI for back issues. Goes to GP and she sends to Specialist. He is given a referral for the MRI. He calls to make apt at radiology facility. They say they don't take Amerihealth NJ, and for us to tell that to Amerihealth (why would that be our job). Anyway we do call and the customer rep tells us "yes you can go to that facility". I have him email me a list of all facilities in our area, and yes they are on there. We then get a written approval from Amerihealth with that specific facility on there, so my husband now goes to facility in person to show them this letter with approved referral for their facility.
They tell him that this local value network is a new division of this Amerihealth and that they have seen nothing but problems with this plan, everything from referrals to payments. And that again we should tell Amerihealth this! Mind you, we pay over $1200 a month for this insurance we can't even use and it's our job to make Amerihealth aware. Also I got this insurance through the government website and that is a whole other nightmare!! Please, if looking into insurance do yourself a favor and look elsewhere!! There should be a way we can sue this company for misrepresenting what they say they are going and can do for you, and they do nothing but take your $$$$.
I have been calling 2-3 times per month regarding an issue with the dental portion of my health insurance and it is now almost August and I still don't have a resolution to my problem. Every time I call, I am told they will put a request in and someone will call me back, and so far I've never gotten a call back and no one will handle the issue.. So I am being overcharged every month and when I don't pay the extra amount I get letters stating that they are going to cancel my coverage, when they are the ones who gave me the new lower premium. And on top of all that, I called 7/10/15 to inform them that my children will be covered under a different insurance as on 8/1/15 and please expire their insurance as of 7/31/2015.
They went ahead and cancelled the insurance as of 7/1/2015 when I had already paid for July and requested exp date of 7/31/2015!!! The phone calls are all recorded so they know it was their error and I have now wasted several hours for the past few days on the phone trying to get my children covered for the month I already paid for and yet I still have not gotten any help... No one is willing to help in any way, they always want to '' call you back'' and never do or put in a request and never call back. It's absolutely frustrating and aggravating and I have never been so unhappy with any company ever in my life!
I have amerihealth insurance. I have a serious condition called cholesteatoma I need surgery for. I need a radical mastoidectomy done. It's an advanced infection and neither my ear drum or bones can be saved. I will also need to get an implant in the future so I can hear. I have to wait till Aug 31 just to talk to the Dr about my ct scan results and I already have them. If you don't get this surgery done fast enough you can get a brain abscess or meningitis which can be fatal. Why would a Dr who swore under oath wait on this? I have headaches every day and now I'm getting bloody noses when I wake up. I really feel this is an insurance issue because they wouldn't even help me find a ENT surgeon to begin with.
I am the group plan administrator for this plan. It was effective 1/1/2015. One employee had minor surgery in March and was denied for no pre-authorization. The surgeon, hospital, etc. are all still attempting to get paid as they obtained pre-authorization. Another employee obtained a referral from his primary care physician for 3 months of chiropractic care. The employee has not been able to continue his treatment as his first three visits were denied for no referral! The office manager has repeatedly resubmitted the referral but the claims are still denied. When called, an AmeriHealth customer rep told the employee, "yes we have the referral" but the claims are still denied. I will be taking this up with the NJ State Department of Ins.
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