AmerihealthConsumerAffairs Unaccredited Brand
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!
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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.
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.
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