ComplaintsforPriority Partners

• Initial Complaint

  07/08/2024

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  We are a medical providers office that saw patients in a behavioral health hospital. The hospital bills ***** which is the mental health coverage for all Maryland ******** and ***** while as the medical provider we bill ******** directly or the appropriate ***. last year Priority Partners started sending retraction letters for going back to 2020 for each and every single patient we ever saw for them. So we reached out and were told to email proof ofthe visits (hospital face sheets) to a specific department by email **********************. Which we have done over and over again and received confirmation that is was all accepted and resolved. Yet we still continue to receive more letters, money actually retracted from future payments on patients where it was already stated as resolved and it is continuing to re requested over and over on already "resolved" cases and we have not received any recent payments due to this. I have tons and tons of files and emails (over 35 at this point just counting the once i have sent with the requested proof) Help!! Maryland Insurance commissioners were contacted as well but we were told they don't have jurisdiction over ******** companies.

• Initial Complaint

  01/30/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  Priority Partners Reference: *** ******* As a recent stroke patient under the care of GBMC and Priority Partners, I've faced significant challenges in accessing timely neurological care. Scheduled for a crucial follow-up appointment on 1/29/2024, it was disheartening to find it canceled due to a lack of referral from Dr. ******** ******* at GBMC. Further complicating matters, obtaining a new referral through Priority Partners' primary care providers has proven to be a lengthy process, with months-long waits for an initial visit. This experience raises serious concerns about the efficacy of Priority Partners in managing the healthcare needs of patients relying on Federal or State programs. The delays and barriers encountered in receiving essential post-stroke care suggest a systemic issue that undermines the very purpose of such programs, which is to provide timely and adequate medical care to all. Given these experiences, it's worth questioning whether Priority Partners is equipped to effectively participate in Federal healthcare programs. If they are unable to facilitate prompt and efficient access to medical services, especially for critical follow-up care like neurology visits post-stroke, this could significantly compromise patient health and recovery. It is crucial for healthcare providers participating in these programs to prioritize patient needs and ensure that bureaucratic processes do not hinder access to essential medical services. The health and well-being of patients should always be the foremost concern.

  Business response

  02/13/2024

  hello 

  This member complaint have been escalated to you leadership. 

  thank you 

  Business response

  02/23/2024

  hello 

  I have tried contact the member couple of time as well left message but I was unable to reach member. I was able to obtain a copy of the members referral. 

  After conducting a comprehensive review of the complaint, it has been determined that an authorization was sent to your neurologist's office on January 29, 2024. We have been informed that you were able to reschedule another appointment. We apologize for any inconvenience this may have caused you and the office regrets the inconvenience that you may have experienced.

• Initial Complaint

  12/22/2022

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I prefer to be contacted via email so I don't miss any calls. I have been trying to redeem a $50 gift card for the wellness checkup but I keep being told my member ID is not valid despite being verified and the claim going through on my doctor's end. I've been getting the runaround from Priority Partners and Blackhawk from card services. Nothing is being done to resolve this and no one seems to have adequate information on the matter so I'm thinking this is fraudulent on the part of Priority Partners to dupe patients into visiting a doctor. Last important info I was told from a representative via phone was the system was not recognizing our new member IDs. My doctor visit was November 2, 2022. I can provide you with my member ID if needed. I've called numerous times and Priority Partners tell me to call Blackhawk and vice versa. I've called both numbers on that email. Utterly useless.

  Business response

  01/10/2023

  We are working very hard to resolve this member's issue. At the time when the gift card was requested the organization was in the middle of system changes, which created complications for our vendor to disperse the gift cards. We are working feverishly to correct the problematic glitches. We did acknowledge the member is entitled to a gift card for her successful completion of her medical care and a card will be mailed as soon as the correction has been updated. Unfortunately, at this time we do not have an ETA from the vendor, but will contact her once we have an update. We apologize for her inconvenience
  
  Priority Partners ****** Services Manager
  **********************
  

  Customer response

  01/11/2023

  
  ******************************* <*******************************************>
  3:18 PM (5 minutes ago)
  to Better
  
  Hello and thank you for actually getting any kind of semi-informed response from them.
  
  Is there an option to temporarily accept the response, to not have the case closed until I actually receive the gift card? I've been at this since November 2022 and if they have not worked out their issues, thus far, I have zero confidence they ever will. I also know they will not keep me informed of anything. I never requested a physical card, I selected the virtual one for faster delivery. They do not seem to be concerned about this issue.

  Business response

  01/13/2023

  We completed a new submission for the member and will be monitoring the tracking to ensure the gift card is received. We appreciate your patience in this matter.

  Customer response

  01/18/2023

  (The consumer indicated he/she ACCEPTED the response from the business.)
  There were a couple of resubmissions Priority Partners did (at least one was rejected) but I finally received my reward card. I'll never use this "incentive" from Priority Partners again. Hopefully the vendor issues have truly been resolved.
  
  I tried for months to get this resolved and I know I'd still be trying be it not for the help of BBB. Thank you!

• Initial Complaint

  09/14/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am a physician and have been trying to get a medication approved for a patient for the past month. The only reason I prescribed this medication is because the insurance plan mandates it prior to approving the actual medication I would like to use for my patient. It has now been over 30 days And I have faxed several forms they have asked for as well as called an uncountable number of times only to be told the same thing which is "call another number" or "we need this faxed" or "we have denied it and now you need this". Despite sending all the information several times I am now at a loss about what to do as I can't speak to a single soul that actually can help. This is a terrible situation for my patient as they are the one who is suffering and also this amount of time that is going into this which seems futile at this point is taking away from other patient care that is also crucial (and much more manageable than dealing with insurance company)

  Business response

  11/02/2022

  Business Response /* (1000, 11, 2022/10/18) */ RE: Caution External Email: BBB Complaint Case# ******** (Ref#XX-XXXXXXXX-XXXXXXXX-XX-XXX) External Inbox ppcustomerservice **************************** 9:54 AM (3 minutes ago) to me Good morning! Thank you for your email inquiry. So that I may assist you further, please provide the details for the member that this complaint refers to and the complainant. For HIPAA verification purposes please provide the member's name, date of birth, complete address, and Priority Partners ID # and the provider/complainant's full name, complete address, NPI and/or Tax ID #. Have a great day! Regards, Lora ** Correspondence Specialist Johns Hopkins Healthcare LLC **** ******* *** ******* ******** ** XXXXX

• Initial Complaint

  11/28/2021

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  In October 2019 I was in a car accident while being 5 months pregnant. The other driver struck the driver's side of my car, and forced me off the road/into a fire hydrant. Quite obviously this prompted me to seek emergency care and an ultrasound to ensure my baby was okay. The other party's insurance was supposed to pay for everything, but they did not cover my ultrasound. I have been attempting to get MY insurance - Priority Partners - to backdate the claim and cover it to no avail. I have tried multiple times for 2 years, now, and they have remained unwilling to help. Now the cost is an outstanding balance on my credit report, which I feel is unfair to me. This is why I have insurance, to pay for medical care, and they have been declining to pay for it for years. At this point, I'm refusing to pay the debt owed. I'm more than willing to ignore it for 7 years so it just gets written off, because I'm not backing down against these greedy, useless people.

  Business response

  02/08/2022

  Business Response /* (1000, 9, 2021/12/13) */ After a thorough review of your complaint, it has been determined that Priority Partners is not responsible for the payment of any claims pertaining to your automobile accident October, 2019. The member informed Priority Partners on 10/29/21 that in October 2019 she was in a car accident while pregnant and needed to go to the ER to ensure her baby was okay. She received a bill for an ultrasound, which was supposed to be put through the insurance of the person who hit her, but for some reason it wasn't and they have since pretended it didn't happen. On 4/29/21, Priority Partners contacted Adventist Healthcare Shady Grove Medical Center, who informed Priority Partners that State Farm was billed and subsequently paid for the medical bills relating to the accident directly to member. This left the responsibility to *** ******* to reimburse Adventist Healthcare Shady Grove Medical Center. Priority Partners was informed that Adventist Healthcare Shady Grove Medical Center contacted *** ******* on two separate occasions, in which the member hung up on them, so they sent the charges to collections. Priority Partners has spoken with the member and advised that the issue is between State Farm, Adventist Healthcare Shady Grove Medical Center and the member. Adventist Healthcare Shady Grove Medical Center also stated *** ******* signed a waiver stating she would be responsible for paying for charges not reimbursed by the insurance company. The member indicated she is not going to pay the bill, they can just leave it in collections and she'll just wait for it to fall off her credit report. -Sierra E. Complaints & Greivance Supervisor Consumer Response /* (3000, 11, 2021/12/14) */ (The consumer indicated he/she DID NOT accept the response from the business.) I do not accept this reply. I was 5 months pregnant and hit by a car. I barely remember most of what was said to me during that difficult time, let alone entire speeches regarding legalities and requirements through insurance. I have insurance for a reason, and if this is how my insurance is going to treat me after I've been a member for years, I will simply change my insurance plan to one that cares about the wellbeing of their patients. I'll be sure to let everyone know how terrible Priorty Partners is, and that they choose to demonize and harass pregnant women after going through trauma. Business Response /* (4000, 16, 2021/12/22) */ Our Initial investigation revealed Shady Grove never submitted the claim to Priority Partners. We believe this is because the member reported as a motor vehicle accident. We are going to contact Shady Grove however this Date of Service is pass the timely filing. We will let you know what we learn from Shady Grove. Sierra E Complaints & Grievance Supervisor

*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. ↩