ComplaintsforCareSource

• Initial Complaint

  09/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  8/30/24 CARESOURCE NEEDS TO PAY CLAIMS 2/27/24 $50 AND 3/7/24 $15 THAT FRANSCICAN SUBMITTED TO THEM. UNFORTUNATELY, If needed my next step is to file with a the Attorney General’s office and CFPB, AND INSURANCE COMMISSION against CARESOIRCE for legal purposes. AND CARESOURCE CAN'T TRY & PUT FALSE INFORMATION ON MY CREDIT.

  Business response

  09/10/2024

  Thank you for sharing this complaint.
  
  Upon review of the concerns noted in the members complaint and to protect the members PHI, CareSource staff contacted and spoke to the member directly on 09/04/2024 to discuss their concerns in detail. We educated the member on the cost sharing responsibility for covered services under her policy.  We appreciate the inquiry. Please contact us if we can provide any additional information. Thank you. 

  Customer response

  09/10/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely,
  
  ****** ******

  Again, CARESOURCE NEEDS TO PAY CLAIMS 2/27/24 $50
  AND 3/7/24 $15 THAT FRANSCICAN SUBMITTED TO THEM RECENTLY. UNFORTUNATELY, My next step is to file with the Attorney General's office AND INSURANCE COMMISSION against CARE SOURCE AS THE INSURANCE CARRIER FOR THE ABOVE. CARE SOURCE ALSO SHOULDN'T TRY AND PUT FALSE INFORMATION ON MY CREDIT which will be disputed.

   

  ***, B.A.

  ************

  Business response

  09/13/2024

  Thank you for sharing this complaint.
  
  Upon review of the concerns noted in the members complaint and to protect the members PHI, CareSource staff contacted and spoke to the member directly on 09/12/2024 to discuss their concerns in detail. The member indicated that Franciscan Health waived the copay, and she no longer has a balance.  We appreciate the inquiry. Please contact us if we can provide any additional information. Thank you. 

  Customer response

  09/19/2024

  
  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely,
  
  ****** ******

  CARESOURCE AS THE HEALTH INSURANCE COMPANY SHOULD HAVE BUT FAILED TO NITIALLY PAID ANY AND ALL MEDICAL BILLS RELATED TO FRANCISCAN/HARRIS AND WITHOUT AND CREDIT BUREAU REPORTING. CARESOURCE REPRESENTAIVE JOY & MELANIE ARE THE BLAME AND DID NOY PROPERLY SERVICE THE INSURANCE ACCOUNT. AND AS LONG AS HARRIS/ANTHONY FRANCISCAN CEASE ANY AND ALL FRAUDULENT COLLECTIONS EFFORTS AND DO NOT TRY AND REPORT ANY FALSE AND FRAUDULENT INFORMATION TO THE CREDIT BUREAU.I ALSO JUST SPOKE TO HARRIS PHONE REP' ANGELO 866-309-5424 AND HE SAID THE HARRIS/ANTHONY FRANCISCAN ACCOUNT IS CLOSED. 

   

  *** CUSTOMER

   

  Business response

  09/23/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, CareSource staff contacted and spoke to the member directly on 09/04/24 to discuss their concerns in detail. We advised that the claims processed correctly with copays applied and educated the member on the cost sharing responsibility for covered services under her policy. An email was sent on 9/09/24 as follow up with a link to plan documents outlining the cost sharing responsibilities for the policy and the member’s right to file a formal complaint. We reached the member again on 09/12/24 and the member indicated that Franciscan Health waived the copay and she no longer has a balance.  This issue is resolved and her rebuttal feedback has been received. We appreciate the inquiry. Please contact us if we can provide any additional information. Thank you. 

  Customer response

  09/25/2024

  
  9/25/24

   

  Complaint: ********
  
  I am rejecting this response because:
  
  Sincerely,
  
  ****** ******

   

  THANKS BBB, AS LONG AS CARESOURCE/HARRIS/ANTHONY FRANCISCAN CEASE ANY AND ALL FRAUDULENT COLLECTIONS EFFORTS AND DO NOT TRY AND REPORT ANY FALSE AND FRAUDULENT INFORMATION TO THE CREDIT BUREAU. I ALSO JUST SPOKE TO HARRIS PHONE REP' ANGELO 866-309-5424 AND HE SAID THE HARRIS/ANTHONY FRANCISCAN/CARESOURCE ACCOUNT IS CLOSED. CARESOURCE SHOULD OF NEVER GAVE FALSE BILLING INFORMATION TO HARRIS/FRANCISCAN. NEXT STEP, COMPLAINTS TO OIG/INSURANCE COMMISSION AGAINST CARESOURCE...

• Initial Complaint

  07/29/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I have confirmed torn labrum since 2017-18 I had surgery schedule to fix it on Monday 7/29/24 cause I am finally going through process to fix it. Caresource denied my surgery when I can’t even left my arm, I can’t work, I can’t take care of my family. They do not care about their clients or customers only about the financial aspect they can drag out making people not get the medical procedures they needed.

  Business response

  08/06/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Grievance Specialist contacted the member directly on 8/6/2024 to discuss their concerns in detail. The Specialist was not able to reach the member so a voicemail was left for a return call. On 8/6/2024, the Specialist sent a letter to the member advising of the plans findings and to please contact the plan if additional assistnce is needed.  Please contact us if we can provide any additional information.  Thank you

• Initial Complaint

  07/22/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  on going phone conversations over a period of several days, a contradiction of information concerning out of pocket and deductibles being met, resulting in problems getting prescriptions and provider care without a bill, we are told by caresource on one occasion that all our obligations have been met, then the opposite the next day and our Dr, and pharmacy are still trying to charge us a copay, issue number two, the pharmacy says that we dont need a preauth for a certain script, caresourse says that we do.

  Business response

  08/15/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Member Services Representative sent a secure email to the member directly on 8/14/2024 containing the plan's findings in detail. The member has been advised if they are still having issues at the providers office to please contact Customer Service for assistance. As well if issues persist with pharmacy to please contact Customer Service for assistaance. Thank you for the inquiry and we believe this issue resolved.  Please contact us if we can provide any additional information.  Thank you

• Initial Complaint

  07/15/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  They charged me a huge amount of money for updated insurance I was never notified about in advance during the open enrollment period in 2023. They had never contacted me, by law, about the changes. No email (after I filed a complaint they admitted to having the wrong email), no phone call, text or snail mail. They first said they would refund my money but then rescinded and passed it to the Insurance Marketplace where I had to deal with them for 7 months including hearings. I was told to contact CareSource for the refund. I spoke to Bryan there who told me he would issue the refund based on the Insurance Marketplace decision but then I was told I have to go back to Insurance Marketplace. I was then on the phone with their hearing dept and received a letter stating I have to go to medicaid to get a letter stating they can tell me I qualify for medicaid from the time where they messed up from last year. I spoke to medicaid and they said it was not their problem, that they should not have even been mentioned. The Insurance Marketplace and CareSource just used this excuse to deflect from their mistake to screw me out of my refund. This is not acceptable. All of this was CareSource's and the Insurance Marketplace's fault and they need to be sued, held accountable and shut down. They both are some of the worst companies I've ever dealt with. They screw the customers, don't rectify their errors or accept their mistakes. They are being reported to the attorney generals office, better business bureau, the media and SEC. Stay away from them at all costs.

  Business response

  07/24/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Member Services Representative contacted and spoke to the member on 7/22/2024 to discuss their concerns in detail. But once the Representative made the introduction the member disconnected the call .  A letter detailing all information regarding the issue was sent to the member on 7/23/2024.  Please contact us if we can provide any additional information.  Thank you

• Initial Complaint

  07/05/2024

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  Paid for the insurance and the first time I tried to use it my medication was not covered. Canceled coverage and only got a partial refund.

  Business response

  07/18/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Member Services Representative contacted the member via email on 717/2024. The Representative  advised the member of the plans findings and what the member will need to do to receive a full refund.  We appreciate the inquiry and believe this will resolve the issue. Please contact us if we can provide any additional information.  Thank you

  Customer response

  07/18/2024

  
  Complaint: ********
  
  I am rejecting this response because: They said to call the Marketplace and have them retro the cancellation date. The Marketplace said that they cannot do that. So I've done what I can Caresource needs to refund the full amount and stop ripping people off.
  
  Sincerely,
  
  ******* *******

  Business response

  07/23/2024

  Upon review of the concerns noted in the members rebuttal and to protect the members PHI, a Member Services Representative contacted the member directly on 7/23/2024 to discuss the concerns in detail. The Member Services Representative was not able to reach the member by phone,  so on 7/23/2024, a secure followup email was sent to the member advising a refund can not be issued without the Marketplace permission.  The member was instructed to contact the Marketplace to cancel enrollment as the plan can not issue a refund with out a file from the Marketplace advising of the enrollment cancellation.  Please contact us if we can provide any additional information.  Thank you

  Customer response

  07/23/2024

  
  Complaint: ********
  
  I am rejecting this response because: This is the same response as before. Worded differently.
  
  Sincerely,
  
  ******* *******

• Initial Complaint

  06/07/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  This company overdrew my checking account by $2007.35 which I never authorized them to do, they were only authorized to for the $28.00 per month premium for my health insurance, they caused me a hardship where I couldn't even buy food to feed my grandchildren, my checking account is overdrawn and I can't pay my rent, now they're telling me I can only get half of that returned and I can't get the rest back and can't use that money for services so basically they get to keep free money.I am a 64yr old grandmother raising my grandkids and can't afford to give away over $2007.35, because of this my blood pressure is high and I'm now suffering from depression

  Business response

  07/23/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Member Services Representative contacted and spoke to the member directly on July 22. 2024 to discuss their concerns in detail. As a result of the discussion with the member, the plan apologized for the inconvience and advised that autopay was recurring and could only be cancelled by the member.  The member was advised that an appeal has been filed with the Marketplace, which the member will await the resolution. The member expressed no additional questions or concerns and ended the call.  Please contact us if we can provide any additional information.  Thank you

• Initial Complaint

  05/07/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  On 12/29/2023, I visited Laboratory Co Of America Holdings (Claim Number ************) for doing annual preventative blood work that is to be 100% covered under the Affordable Care Act, however, I was charged a copay of $50. Under Section 2713 of the ACA, private health plans must provide coverage for a range of recommended preventive services and may not impose cost-sharing (such as copayments, deductibles, or co-insurance) on patients receiving these services. As such it is illegal to charge the patient co-pay for preventive service. Kindly request CareSource to reprocess the claim to cover 100% of the charges and settle the amount to the laboratory.

  Business response

  05/17/2024

  I do apologize I miscounted the days.

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Member Services Representative contacted and spoke to the member directly on 5/15/2024 to discuss their concerns in detail and provide the education on how the the claim was submitted and processed. The member still did not agree with the findings of the plan. Please contact us if we can provide any additional information.  Thank you
  

  Customer response

  05/27/2024

  I have not received any resolution. Basically, the person who called me appeared to have called for the sake of calling, and did not offer any kind of resolution to fix the issue. Very dissatisfied.

  Business response

  06/05/2024

  Upon review of the concerns noted in the members rebuttal and to protect the members PHI, a Member Services Representative contacted the member directly on 6/5/2024 to discuss their concerns in detail. The Member Services Representative was not able to reach the member by phone so a secure email was sent with the plan’s findings in detail on 6/5/2024.  The plan is still waiting on the provider to provide the necessary information to resolve this issue. The member has been notified via email and advised that the plan will contact them as soon as we hear from the provider. The member was also advised if they had any questions to send an email to the Kentucky inbox which the email was provided to the member. Please advise if anything additional is needed.  Thank you.

  Customer response

  06/25/2024

  I received information from Labcorp that they resubmitted the claim to Caresource on May 30, 2024 and it is still in pending status. Kindly request to expeditiously process this claim and correct the situation.

  Business response

  07/23/2024

  Upon review of the concerns noted in the members rebuttal and to protect the members PHI, a Member Services Representative  sent the member and the member acknowledged receipt of the email on 7/23/2024, that a corrected claim was received from the lab. Once the claim is processed the member will be advised of payment amount and date.  Please advise if we can provide any additional information. Thank you.

  Customer response

  08/02/2024

  CareSource still didn’t fix it right. They still charged Copay for preventative services which needs to 100% paid by Insurance.

• Initial Complaint

  05/02/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Resolved

  More info

  In early April, I contacted CareSource regarding a missing reward for completing a Bone Density Exam, listed on the MyHealthy Rewards website. However, I was informed by a customer service agent that I must be 65 years old to qualify, contrary to the stated eligibility of "adults age 50+" on the CareSource website. (please see attached screenshot). Furthermore, there are discrepancies in the information provided regarding cholesterol and colonoscopy screenings. According to the agent, these screenings are required once every 5 and 10 years respectively, contradicting the information on the website. (please see attached screenshots). I attempted to reconcile this discrepancy by requesting further clarification, but unfortunately, the agent was unable to provide an explanation. Subsequently, I requested written confirmation of eligibility and received a brochure a week later, confirming the exact information displayed on the website. On 4/19, after receiving the brochure, I spoke to a Supervisor who informed me that perhaps I received an old brochure and that she cannot control which brochure I receive, nor can she contact the rewards or brochure department directly. She assured me that she would seek clarification and promised to call me back within 2 days. However, as of May 2nd, I have not received any communication from Joni or any other representative from CareSource. It is very frustrating to encounter so much difficulty in resolving what should be a straightforward matter. To ensure clarity and consistency moving forward, I kindly request official documentation detailing the following: 1. Eligibility criteria for rewards associated with specific health screenings, including but not limited to Bone Density Exams, cholesterol screenings, and colonoscopies. 2. Age requirements for participation in the MyHealthy Rewards program and eligibility for rewards. 3. Frequency and timing of screenings required to qualify for rewards, as outlined by CareSource.

  Business response

  05/10/2024

  Upon review of the concerns noted in the members complaint) and to protect the members PHI, a Member Services Representative contacted and spoke to the member directly on 5/10/2024 to discuss their concerns in detail. As a result of the discussion with the member, we were able to fully resolve the issue and the member expressed no additional questions or concerns at that time. We appreciate the inquiry and believe this resolves the issue. Please contact us if we can provide any additional information.  Thank you

  Customer response

  05/10/2024

  
  Better Business Bureau:
  
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me.
  
  Sincerely,
  
  ***** *****

• Initial Complaint

  04/30/2024

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I cancelled my healthcare insurance policy with CareSource on or about 12/15/2023 on the HealthCare.Gov internet site as required / directed. My user portal on the HealthCare.Gov internet site immediately posted that my policy with CareSource was cancelled. I contacted CareSource on or about 12/15/2023 to notify them of the cancellation via the HealthCare.Gov internet site. Their rep informed me that they could not update my account until notified by the HealthCare.Gov system. I asked CareSource to note my account regarding the cancellation. When asked why I cancelled, I told them that I was switching to medicare beginning 1/1/2024. CareSource processed an auto bill / payment to my credit card account for about $339. I contacted them to reiterate that my policy was cancelled and asked that they stop processing auto billing and issue a chargeback. They refused. I filed a dispute with my bank and the charge was found to be made in error and my account was adjusted accordingly. In late January 2024, CareSource processed a new auto bill to my credit card for about $678. When contacted, they refused to stop processing auto billing and refused to process a chargeback. I filled a dispute with my bank and the charge was found to have been made in error and my account was adjusted accordingly. Around the same time, I contacted HealthCare.Gov for their assistance in resolving my issue with CareSource. They told me that they had a record of notifying CareSource of my cancelled policy. They also confirmed that my policy was cancelled timely, i.e., no premiums were due after coverage ended 12/31/2023. CareSource auto billed my account in late February ($1,017) and late March ($1,356). Those charges were successfully disputed via my bank. My bank took measures to prevent CareSource from processing any further auto bills. On 4/8/2024 CareSource billed me by USPS mail for about $1,695. CareSource continues to bill me for a cancelled policy.

  Business response

  05/09/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Member Services Representative contacted and spoke to the member directly on 05/07/2024 to discuss their concerns in detail. As a result of the discussion with the member, we were able to fully resolve the issue and the member expressed no additional questions or concerns at that time. We appreciate the inquiry and believe this resolves the issue. Please contact us if we can provide any additional information.  Thank you

• Initial Complaint

  04/03/2024

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  I was giving the wrong member ID number. The one given to me was to my old Medicaid account. I used that number to pay what I thought was my marketplace account. Spent quite awhile on the phone with both Medicaid department and market place department with no success. I was told there is no way to make a payment on a Medicaid account but I did.. I have payment confirmation receipt that will be attached. I need that money either refunded or moved over to the correct account. Payment was paid to member id ***********. It should have been paid to *********.

  Business response

  04/26/2024

  Upon review of the concerns noted in the members complaint and to protect the members PHI, a Member Services Representative contacted the member directly on four diferent occassions twice on 4/25/2024 and twice on 4/26/2024  to discuss their concerns in detail. The Member Services Representative was not able to reach the member by phone so a voicemail was left advising for a return call to discuss the resolution. Also, an email was sent on 4/26/2024 advising we are trying to reach them to provide the resolution, and to contact member services.  We appreciate the inquiry and hope the member will respond to our voicemail to resolve her issue. Please contact us if we can provide any additional information.  Thank you

  Customer response

  04/30/2024

  
  Complaint: ********
  
  I am rejecting this response because: I regret to inform you that I was unavailable during the times of your attempted calls. My working shift conflicts with your business hours. With that being said, I spent nearly an hour on the phone with your representatives previously, and I encountered difficulty in resolving the issue and was given conflicting information. Therefore, I need to properly set up a time for further discussion. My primary objective is to address the matter of refunding the payment made to member ID number ***********. Again the payment confirmation receipts are attached (for the money paid to the account for member ID number ***********) for your reference. 
  Sincerely,
  
  ****** *****

  Business response

  05/14/2024

  Good morning

  The CareSource Member Services Representative was only able to reach via email. They advised the member that the payments had been applied to her marketplace account.  By the time the Members Services Rep finished we could no longer provide any information through the BBB portal. We go believe after the emails this has resolved the members issue. Please advise if we need to provide any additional information.  Thank you

*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. ↩