ComplaintsforOscar Health Care Plan Inc

• Initial Complaint

  07/08/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  I have been taking testosterone injection for 9 years with my pcp for low testosterone that is well documented in my charts and that all my insurances companies in the past did covered the medication including Oscar health that covered testosterone injection 2 years ago. I have a meeting on Monday with my Dr because this medication is medical necessary and will cause harm to stop all the sudden. I just have surgery and it has been Almost 2 weeks since my last injection since the denied. Oscar customer service is in la ***** and unfortunately they are lost and don't understand the medication system and every time you call they either don't know or won help and will keep transferring you to different extensions. We need a supervisor in *** that can explain in detail what my doctor needs to send or call to be able to fix this issues. Please help this people are inhumane and don't care at all about my health. Fyi.. I am a registered nurse in *** and know how the system and insurances works and they are denying the claim with out a proper grounds for denial. I am trying to find a solution between Oscar and my dr other wise if this don't work I will have to get legal help. My doctor already sent paper work and on Monday we are meeting to see if we can contact oscar directly.

  Business response

  07/18/2023

  Thank you for contacting Oscar regarding the concerns expressed on behalf of our member. We have researched this case and determined the following: 
  Our member expressed dissatisfaction regarding the denial of her medication issued by Oscars Pharmacy Team. The member states that she has had difficulty obtaining her medication and is requesting the assistance of an Oscar supervisor.
  Due to the public nature of the BBB forum and the sensitive nature of this matter as it pertains to member medication and medical diagnosis the Plan cannot provide details in this response. This is not an appropriate or secure forum to discuss this issue in detail with the member. Kindly note, we are responding in good faith with the limited information we can provide on a public forum. If our member would like a more detailed response we would encourage them to contact Oscar directly for assistance so that we might provide our member with a more detailed response in a non-public forum.
  Our records show that our members provider had submitted a prior authorization request to Oscars Pharmacy Team for prescription medication. This authorization request was denied due to the lack of medical necessity. The denial indicated that our member could work with their provider to submit new documentation to support medical necessity and appeal the denial. Please note, Oscars Pharmacy Team processes all prior authorization requests based on the information submitted by the prescribing provider.
  As of the date of this correspondence, our members appeal has been received and processed by our Pharmacy Team. As such, a determination letter was issued and mailed to the members address on file. We can confirm that our member has been working closely with an Oscar supervisor in reference to their medication authorization request and has been notified of the authorization determination directly.
  
  

  Customer response

  07/18/2023

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution would be satisfactory to me.  I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
  
  Regards,
  
  *************************
  
   
  

*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. ↩