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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.
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