ComplaintsforStrata Health Group

• Initial Complaint

  10/11/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I enrolled in a multi plan PPO in January 2024, where they were supposed to be in network and pay a discount for Services. I was provided with the insurance information cards for the plan and it there is a claims number clearly stated on the back where my doctors billing department could submit claims. Apparently nothing has been done since March claims have been unpaid no explanation given cant get through to the customer service number tried multiple times, obviously a scam but they accept my $370 per month and the initial $400 for an enrollment fee to be in a nationwide PPO network. I basically I paid $370 for nothing. I didnt even get medication coverage that I was supposed to get discounts .I ended up going with good RX because they gave a better discount when I first asked about this back in February. They said oh theyre just not familiar with this, but I asure you theres no problem with it its very easy to use ! , Well apparently my doctors offices which there are several are all coming now with statements are with hundreds and thousands of dollars old for services back in March and April that Im just finding about it now !!! Had I known this I wouldve canceled immediately I need Help. I cant get through to anyone but they do collect my money every month please help me .!

  Business response

  10/15/2024

  Dear Ms. ********************* you for making Adroit Health Group (Adroit or the Company) aware of your dissatisfaction with your Impact Health limited medical plan.  As you know, a limited medical plan is not comprehensive health coverage and is only intended to provide members, and their covered dependents, with basic insurance benefits that are capped at specific amounts for specific services.  Per the terms of your policy, you are to be paid a fixed indemnity benefit in the event of a covered accident or sickness.  The fixed indemnity benefits include the following:  (1) hospital confinement benefit--$100/day for up to thirty days per coverage year; (2) physician office visit (primary and specialist) benefit--$50/day for up to three days per coverage year;  (3) emergency room benefit--$50/day for up to one day per coverage year.  However, as you have been made aware, your plan also included a 12-mpnth pre-existing condition limitation whereby claims related to conditions for which you have received care in the preceding twelve (12) months would be excluded from coverage. 
  
  At the time of your enrollment for the Impact Health limited medical plan, you were presented a written Enrollment Agreement by your sales agent.  This Enrollment Agreement was reviewed and executed by you on December 7, 2023, at 11:11 a.m.  The purpose of the Enrollment Agreement is to memorialize what you are agreeing to purchase and to make sure that you receive full and complete disclosures of all material terms of your plan.  To that end, your attention is called to the following disclosures from your Enrollment Agreement:
  
  1.   Impact Health Limited Medical plan is made available through the ***************** of Employers and offers affordable benefits designed for individuals and families who need basic, routine wellness coverage or expanded coverage to help address day-to-day health care expenses.  (******* Enrollment Agreement, 12/7/2023, p. 2)

  
  2.  A Limited Benefit Medical plan is NOT A COMPREHENSIVE MAJOR MEDICAL PLAN, NOR IS IT INTENDED TO REPLACE A MAJOR MEDICAL PLAN. The plan is intended to provide members, and their covered dependents, with basic insurance coverage that is capped at specific amounts for specific services. (******* Enrollment Agreement, 12/7/2023, p. 3, emphasis added)
  
  3.  THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (******* Enrollment Agreement, 12/7/2023, p. 3, emphasis original)
  
  4.  You understand that you have a free trial period of 30 days. During this trial period or free look, you can cancel this membership and receive a full refund excluding the onetime enrollment fee, as long as you have not used any benefits. (******* Enrollment Agreement, 12/7/2023, p. 4)
  
  5.  You understand that the insurance coverage included with this membership is an accident and sickness hospital indemnity plan. (******* Enrollment Agreement, 12/7/2023, p. 4)
  
  6.  You confirm that the details of the accident and sickness hospital indemnity plan have been explained to you by your agent, including the limitations and exclusions. (******* Enrollment Agreement, 12/7/2023, p. 4)
  
  7.  This policy provides limited benefits on a fixed indemnity basis. It does not constitute comprehensive health insurance coverage (often referred to as major medical coverage) and does not satisfy a persons individual obligation to secure the requirement of minimum essential coverage under the *************** Act (ACA). (******* Enrollment Agreement, 12/7/2023, p. 4)
  
  8.  You understand the plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment. (******* Enrollment Agreement, 12/7/2023, p. 4)
  
  9.  You understand that if you have a pre-existing condition, the accident and sickness hospital indemnity benefits may not be immediately available for claims associated with this condition. (******* Enrollment Agreement, 12/7/2023, p. 4)
  
  10.  You understand specifically, if you have had care rendered or prescribed to you by a physician within the 12 months leading up to your effective date, you will have a waiting period for 12 months before any claims related to your condition will be covered. (******* Enrollment Agreement, 12/7/2023, p. 4)
  
  11.  You understand that the BENEFITS INCLUDED WITH THE ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN ARE NOT DEPENDENT ON THE USE OF THE MULTIPLAN PPO NETWORK. (******* Enrollment Agreement, 12/7/2023, p. 5, emphasis added)
  
  12.  You understand that if there are any discrepancies between what the agent told you about the plan and what the actual policy states, that the policy terms will apply. (******* Enrollment Agreement, 12/7/2023, p. 5)
  
  13.  Pre-existing Condition Limitation - There is NO COVERAGE FOR A PRE-EXISTING CONDITION FOR A CONTINUOUS PERIOD OF 12 MONTHS FOLLOWING THE EFFECTIVE DATE OF A COVERED PERSONS COVERAGE under the Policy. (******* Enrollment Agreement, 12/7/2023, p. 6, emphasis added)
  
  14.  I agree that I have a full and complete understanding of the products for which I am applying. (******* Enrollment Agreement, 12/7/2023, p. 13)
  
  15.  By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. (******* Enrollment Agreement, 12/7/2023, p. 13)
  
  As reflected in the contractual excerpts referenced above, your policy was not comprehensive health insurance, and instead provided only limited benefits in the form of fixed indemnity payments that are payable directly to you and not paid to your providers.    This was clearly disclosed to you in writing at the time of sale, and you were afforded a full thirty-day period to review the account and all coverages during which you were free to cancel for any reason and receive a refund of your charges.  
  
  To clarify, the use of an in-network provider does NOT affect your eligibility for benefits under your Impact Health limited medical plan. However, utilizing an in-network provider, while not required, is advisable because it reduces the out-of-pocket costs you incur against which those fixed indemnity payments can be applied.  Therefore, you would receive the same $50 benefit for a physicians office visit regardless of the physician you utilizedwhether in-network or out-of-network.  For example, the use of an in-network provider might result in you being charged $75 for that visit versus $125 for an out-of-network provider, for which you would have received the same $50 payment from your plan.
  
  Therefore, assuming that the services you received were for covered accident or covered sickness, and assuming again that those services were not for a pre-existing condition, your policy would pay you $50 per day for physician services (either primary care or specialist or a combination thereof) for a maximum of three days.  
  
  Unfortunately, our Company is not the insurance carrier nor are we the carriers third-party claims administrator.  This means that Adroit has no involvement with, nor any authority over, the claims reviews, claims processing, and claims payment.  Hence, we have no visibility into the basis for any claims determinations that may or may not have been made, nor do we have any ability to resolve your claims-related issues all of which reside solely with your carrier and its third-party claims administratorneither of whom are Adroit. 
  
  We acknowledge that you have contacted Adroits ************************** with several claims inquiries, at which time you were directed to the ***************** at the carrier.  As you have been previously advised, all questions regarding claims status and payments should be directed to International Benefits Administrators, who is the third-party claims administrator for the Impact Health Plan.  Their contact information is as follows:  International Benefits Administrators, Attn: ************* Post Office Box 576, ******* ********, *****, telephone:  ************.  If you believe that your claims are not being properly addressed, we urge you to follow up directly with International Benefits Administrators at the number provided above.
  
  With regards to your complaint concerning medication coverage, we note that your Impact Health limited medical plan does not provide prescription coverage, although you do enjoy certain prescription discounts through your membership as noted on your membership identification cards and plan materials.  A copy of your membership identification card reflecting these discounts is enclosed with this response for your ongoing reference.
  
  Adroit regrets that you have been unable to receive a sufficient response to date from Impact Health and its third-party administrator, International Benefits Administrators, and we apologize for the challenges you have encountered.  We have attempted to relay your problems to the *** in hopes that they follow up with you directly.  Further, we note that, as a courtesy, you have been refunded your most recent four (4) months of payments in the amount of $307.70 each.  Receipts evidencing these four refunds are appended to this response for your reference.
  
  Best regards,
  
  ******* *****
  General Counsel & Chief Compliance Officer

  
  

• Initial Complaint

  08/23/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I would like to formally make a complaint against Adroit Health Group, its affiliate Strata Health group, and the underwriting agency ****************** Security Life insurance *** (AFSLIC). Strata Health group and its employees failed to fully disclose pertinent information regarding plans and policies being offered to us for enrollment. Strata allowed its employees to fraudulently represent a discount plan as an affordable healthy family plan by using misleading language as a sales tactic and failing to inform us of essential information necessary in making informed consent for enrollment. My husband and I (**** & *****************************) were never informed or disclosed to that we were enrolling in/enrolled in a discount services program and NOT a traditional health insurance plan like we were led to believe by Strata Health groups and its employees resulting in a failure to provide adequate health coverage for our family. We have repeatedly been sent balance bills from multiple hospitals and offices as well as phone calls from hospital billing departments as recently as this month, August 2024, all from claims made during the covered period in 2022/23 for both my son and myself that were denied any coverage by Strata health. A recent notification sent via text message from *********************** on 8/19/24 indicating a cancelled payment plan is what sparked further investigation and discovery of the fraud and deception we have been subjected to by Adroit Health Group, its affiliate Strata Health group, and the underwriting agency ****************** Security Life insurance *** (AFSLIC). In total we paid Adroit Health Group $13,951.55 for nothing more than a discount services program and have received bills and continue to receive bills totaling $8778.82, some of which we had to pay some that are considered pending and are due. I hope that in pursing these complaints someone can help inform and support me with any and all available options to mitigate these discrepancies.

  Business response

  08/27/2024

  Dear ******************,
  
  Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with your Impact Health limited medical plan purchased through our Company.  While our Company regrets that you did not find that the products purchased on our platform sufficiently met your family's needs, we feel compelled to address certain erroneous allegations raised in your complaint.
  

  You are in error when asserting that our Company allowed our employees to make purported misrepresentations to your husband when he purchased the account.  ******************** does not engage in any direct-to-consumer sales.  Rather, our company is a general agency and field marketing organization that solely makes certain insurance and non-insurance products available for sale by licensed third-party sales producers through our enrollment and billing platform.  All sales on our platform are conducted by third-party agencies and their agents who are not employed by Adroit, nor does our Company have any ownership or operating interest in same.  If you believe a sales producer misrepresented a product to you, your complaint should be directed to that sales producer, whose contact information is included in the product materials provided to you at the time of sale.  
  
  Moreover, in order to ensure that customers purchasing products on our platform understand what they are purchasing, Adroit requires that all sales on our platform be completed through the presentation and execution of a written Enrollment Agreement.  Your husband received the Enrollment Agreement and signed the contract on August 19, 2022, at 12:51 p.m., indicating his understanding and acceptance of the terms.  A copy of your husbands Enrollment Agreement is included with our response for your reference. The purpose of this Enrollment Agreement is to provide important disclosures concerning material aspects of the transaction, specifically including but not limited to product benefits, exclusions and limitations, and associated costs.  At the time of enrollment, you received access to our online Member Portal that includes all plan documents, including product guides. Further, Adroit provides all customers with a thirty-day period to review the transaction and cancel without obligation for any reason in the event you find anything in the account and the products to not be to your liking.  Despite this thirty-day review period, you did not elect to cancel the account and continued enjoying the benefits of your Impact Health limited medical plan until November of 2023.  

  As will be shown in more detail below, all statements made by Adroit in the Enrollment Agreement were factually accurate and consistent with how your account was subsequently handled.  Likewise, your assertion  that you were never informed or disclosed to that we were enrolling in/enrolled in a discount services program and NOT a traditional health insurance plan like we were led to believe is also in error.  First and foremost, your husband purchased a limited medical plan, whose modest coverages commensurate with the modest cost for same was clearly disclosed to you at the time of purchase.  This limited medical plan is decidedly more than a discount plan as you have alleged, although you are correct that it is not comprehensive health insurancea fact that was also clearly and repeatedly disclosed to you at the time of purchase.  Specifically, your attention is called to the following specific disclosures in your Enrollment Agreement:
  
  1.  Impact Health A Limited Benefit Medical plan is NOT A COMPREHENSIVE MAJOR MEDICAL PLAN, NOR IS IT INTENDED TO REPLACE A MAJOR MEDICAL PLAN. The plan is intended to provide members, and their covered dependents, with basic insurance coverage that is capped at specific amounts for specific services. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis added.)
  
  2.  THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis original.)
  
  3.  You understand that the insurance coverage included with this membership is an ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN. (******* Enrollment Agreement, 08/19/2022, p. 4, emphasis added)
  
  4.  THIS POLICY PROVIDES LIMITED BENEFITS ON A FIXED INDEMNITY BASIS. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS MAJOR MEDICAL COVERAGE) AND DOES NOT SATISFY A PERSONS INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). (******* Enrollment Agreement, 08/19/2022, pp. 4-5, emphasis added.)
  
  5.  You understand the plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment.  (******* Enrollment Agreement, 08/19/2022, p. 5)
  
  6.  You confirm that the details of the accident and sickness hospital indemnity plan have been explained to you by your agent, including the limitations and exclusions. (******* Enrollment Agreement, 08/19/2022, p. 4)
  
  7.  You understand that you have a free trial period of 30 days. During this trial period or free look,  you can cancel this membership and receive a full refund excluding the onetime enrollment fee, as long as you have not used any benefits. (******* Enrollment Agreement, 08/19/2022, p. 4)
  
  8. You understand that if after using the program, at any time you are not satisfied, you may cancel your membership, and your benefits will be terminated at the end of the billing cycle for which you were billed. You, then, will not be billed any further. (******* Enrollment Agreement, 08/19/2022, p. 4)
  
  9.  You understand that if there are any discrepancies between what the agent told you about the plan and what the actual policy states, that the policy terms will apply. (******* Enrollment Agreement, 08/19/2022, p. 5)
  
  10.  I understand the details of the membership including the membership fees. I have read and agree to the General Membership Disclosures. I have read and agree to the Insurance Disclosures). (******* Enrollment Agreement, 08/19/2022, p. 7)
  
  11.  I agree that I have a full and complete understanding of the products for which I am applying. (******* Enrollment Agreement, 08/19/2022, p. 11)
  
  12.  By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. /s/ *********************** (******* Enrollment Agreement, 08/19/2022, p. 12)
  
  We do note, however, that in addition to the Impact Health limited medical plan, your husband did purchase several other discount products, which may well be what you are alluding to; however, these products are not insurance which was also disclosed at the time of purchase and did not carry the benefits that you were attempting to use at your various health care providers (which were included in your Impact Health limited medical plan.  Nevertheless, the disclosures for these other products also specifically reference that they are not comprehensive health insurance, to wit:
  
  13.  Wellness Plans of *******, WPA, is NOT MAJOR MEDICAL OR COMPREHENSIVE MEDICAL INSURANCE COVERAGE, AND IS NOT A MINIMUM ESSENTIAL HEALTH BENEFIT PLAN UNDER FEDERAL AND/OR STATE LAW. The benefits will not satisfy the individual mandate as defined by the Patient Protection and *************** Act. ). (******* Enrollment Agreement, 08/19/2022, p. 8, emphasis added)
  
  14.  Wellness Plans of America, WPA, is NOT MAJOR MEDICAL OR COMPREHENSIVE MEDICAL INSURANCE COVERAGE, AND IS NOT A MINIMUM ESSENTIAL HEALTH BENEFIT PLAN UNDER FEDERAL AND/OR STATE LAW. The benefits will not satisfy the individual mandate as defined by the Patient Protection and *************** Act. defined by the Patient Protection and *************** Act. (******* Enrollment Agreement, 08/19/2022, pp. 8-9, emphasis added)
  
  As clearly evidenced hereinabove, you were advised multiple timesincluding disclosures with bolded text for emphasisthat the products you were purchasing did NOT constitute traditional health insurance.  You were also provided specific information concerning the limited coverages that were available under your plan, including the specific services and indemnity payment that would be paid to you by the carrier.  A copy of the plan certificate that was made available to you in the electronic Member Portal is also enclosed with this response.  You will note that the Impact Health limited medical plan pays a fixed indemnity benefit directly to you, and not to your health care provider.  As detailed in that plan certificate and your Enrollment Agreement, the Impact Health plan did, in fact, provide substantial benefits, which were significantly more robust than mere discounts as has been alleged, including:
  
  - Hospital Confinement Benefit - $500 per day of confinement up to a maximum of 30 days per coverage year.
  
  - ***************** Benefit - $50 per day for ************ or ***************** Visit for a maximum of 5 days per coverage year.
  
  The Impact Health Plan also includes fixed indemnity benefits for surgery, Diagnostic X-ray and Laboratory Testing (including interpretation), emergency room services, mental health services, and supplemental benefits related to accident, critical illness, and accidental death.  Therefore, it is simply erroneous to claim that you received nothing more than discount services.  If you, in fact, believe that your claims under the Impact Health plan were improperly denied, you should pursue your appeal rights through the plan as spelled out in the Plan Certificate, which is attached.  Unfortunately, Adroit is not the insurance carrier nor are we a third-party claims administrator, and therefore we have no involvement with nor authority for claims review, claims processing, and claims payment.  
  
  With regards to your claim that your providers claims were denied, we should again point out that our Company does not have any involvement with claims, and therefore, it is inaccurate to assert that our Company denied your coverage.  Conversely, we again reiterate the provisions of your plan stating that the benefits under the Impact Health limited medical plan are payable directly to you and not to the provider.  Therefore, if your provider is indicating that it did not receive a payment as you have alleged, that non-payment would be consistent with the terms of your plan, and instead, you should follow up with the carrier to obtain the indemnity payment provided under the plan which, as indicated in your certificate is payable to you.
  
  Furthermore, with regards to the text message you received from your hospital on August 19, 2024, indicating that you had a cancelled payment plan, we note that your account was cancelled at your request on November 17, 2023 (with an effective date of November 24, 2023).  A copy of the cancellation confirmation e-mail that was sent to you at that time is appended to this response for your reference.
  
  In sum, there is no evidence of any fraud and deception on the part of Adroit Health Group, and we respectfully dispute any such allegations.  You were provided ample disclosures and consistent, accurate information by Adroit concerning the products, coverages and limitations, and costs for same.  You were provided a full thirty-day period to review the transaction and cancel for any reason.  If you believe claims may have been improperly denied, your best recourse is to follow up directly with the carrier and/or its third-party claims administratorneither of whom are Adroit.  
  
  We sincerely regret that you were dissatisfied with the products purchased through our Company, but we believe you have been treated fairly.  Nevertheless, as a courtesy, Adroit is willing to refund your most recent payment in the amount of $852.35.  This should not be construed as an admission of any fault or liability on the part of Adroit Health Group, but instead represents a transaction and compromise of a disputed claim that is being done as a courtesy for a valued customer.  However, the refund would be for the October-2023 payment, and therefore if you have any pending claims for this time period, it might result in the denial of those claims.  Therefore, we want to give you the option to pursue any outstanding fixed indemnity claims with the carrier.  If you have no claims for this period and/or wish to forego any reimbursement for same, kindly e-mail Adroits ********************* at ****************************, referencing this BBB complaint.  Based on your request and understanding the potential claims impact, we will be happy to direct a refund of the October-2023 payment.
  
  Should you have any further questions, please feel free to contact Adroit Health Groups ********************* via e-mail at ****************************.  
  
  Best regards,
  *************************
  General Counsel & Chief Compliance Officer

  
  

  Customer response

  09/04/2024

  To whom it may concern,
  
  
  While I do appreciate your prompt response in addressing my grievances with your companies product, Im greatly disappointed at the lack of concern in regard to the representation and sale of those products to consumers by third-parties. Id hoped that in alerting you of such misrepresentation your company would have taken the necessary action to further assess the situation before denying any fraud or responsibility. Strata/Adroit Health Group does indeed have a responsibility to its consumers to comprehensively identify, *****, and mitigate possible risk potential with regard to the representation and sale of your products by third parties as part of your due diligence. Therefore, I do believe there is a degree of responsibility that should be addressed on behalf of your company. 
  
  
  Although I can understand why you would include the enrollment contract as evidence of tranperency, I made it very clear when I filed my complaint that the contract was NOT signed in good faith. The product was undoubtedly misrepresented to us by the third party individuals selling your product. And as I also pointed out, our point of sale transaction was processed and collected by Adroit Health Group in June of 2022 and continued monthly until November of 2023 when we cancelled. You listed the contact signature as August of 2022, an obvious discrepancy as the payment was in fact processed in June of 2022 two months prior to the date you have listed as the contact date. Although you emphasize in your response what the contract coverage parameters are, my husband and I both do not recall those parameters ever being disclosed verbally, in plain English, in real time, over the phone during the point of sale. Further more, I do not agree that signing a contract in real time via a text message link as adequate time to review or understand the parameters of what is being signed, especially when the product have not been represented truthfully. Also, with regard to the patient portal link information being mailed to us to access the contract as evidence of disclosure, I would like to point out again that we enrolled in a short term medical plan prior with no major issue, so when presented with another policy (Impact Policy) framed as similar by the agent in June of 2022 ( using misleading language such as  PPO, A great option for health families, 70/30%) we had no reason to suspect otherwise. 
  
  
  Misrepresentation alone IS considered grounds to invalidate the contact. While I can understand why you would include the above stated items as evidence of disclosure, Ill remind you that none of this was disclosed or understood at the point of sale over the phone. We were clearly taken advantage of and sold a policy that did not deliver what was promised. Although I may have noted minor changes in the begining, nothing to the degree that would alert me to the serious lack of coverage for our family until months after and well outside of the 30 day cancelation period. Had it not been for my shoulder injury in April of 2023 and my sons broken arm in May of ***************************************************************** monthly premiums for what we thought was major medical insurance but was in fact nothing more than limited and discount coverage at best. 
  
  
  I would like to yet again note that we did not start to receive balance bills until months after the ORIGINAL service dates of ****** **** and June of 2023 (specifically October of 2023 for myself and November of 2023 for my son). All of which were billed during the covered period between June of 2022 and November of 2023. Those bills were the FIRST MAJOR indication that there was a lack in coverage, hence the cancellation in November of 2023. Although concerned with the amount of money we owed in back billing, we did not understand the scope of how truly misinformed we were until August of 2024 with the notification of outstanding bills and discovery of MORE pending bills we currently face. All from the covered period of June 2022-November of 2023 for which we thought we had purchased major medical coverage, but clearly was not. 
  
  
  Im saddened at your ***** presumption of fairness as the lack of which has undoubtedly been made clear. I am greatly disappointed at the unwillingness of Adroit/Strata Health Groups to accept any accountability whatsoever. While I do not believe your company had any direct malicious intent towards me, I am appalled at the lack of empathy expressed in your response as your company did in fact benefit from the misrepresented sale of the Impact policy to usregardless of who sold it. I do believe that it is your companies responsibility to comprehensively assess third party risk by those representing and selling your products as part of your due diligence to ensure that they are being represented truthfully and responsibly to consumers. Therefore I feel we have grounds to ask for a full refund in the amount of $13,951.65 for the monthly premiums billed during the period of June 2022 - November of 2023 for which we were sold, and enrolled in a policy that was falsely represented and for which Adroit Health Group accepted payment for. 
  
  
  Furthermore, in an effort to be transparent I would like to disclose that 
  any error on billing/notification has been addressed with the medical and hospital billing departments respectively and all parties have been made aware of the current situation. All grievances with the agency and individuals involved in the sale have been addressed in separate complaints that have been filed with the appropriate agencies both on a states and federal level. 
  
  
  I sincerely hope that these grievances are taken seriously and that we can work together to find a reasonable solution. 
  
  
  Best, 
  ***************************;
  
  

  Customer response

  09/04/2024

  I am rejecting this response because:   

  I have sent further information to the BBB for review. 

  Business response

  09/05/2024

  Thank you for your thorough response.  We have previously attempted to address each of your concerns at length as well as offer a partial refund to you as a courtesy, which we again renew to you now.
  
  To reiterate our prior response, our Company does not engage in any direct-to-consumer sales and we, in fact, made no misrepresentations to you whatsoever.  If you believe a sales producer misrepresented a product to you, your complaint should be directed to the third-party sales producer with whom you dealt and whose contact information is included in the product materials provided to you at the time of sale.  To the contrary, our Company made every effort to provide you with accurate and complete disclosures of the product benefits, exclusions and limitations, and associated costs.  Specifically, your attention is called to your Enrollment Agreement dated August 19, 2022, containing numerous disclosures concerning the products you were purchasing and specifically noting that these products were not major medical insurance.  These important disclosures included, again, each of the following (without limitation):
  
  1.  Impact Health A Limited Benefit Medical plan is NOT A COMPREHENSIVE MAJOR MEDICAL PLAN, NOR IS IT INTENDED TO REPLACE A MAJOR MEDICAL PLAN. The plan is intended to provide members, and their covered dependents, with basic insurance coverage that is capped at specific amounts for specific services. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis added.)
  
  2.  THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (******* Enrollment Agreement, 08/19/2022, p. 3, emphasis original.)
  
  3.  You understand that the insurance coverage included with this membership is an ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN. (******* Enrollment Agreement, 08/19/2022, p. 4, emphasis added)
  
  4.  THIS POLICY PROVIDES LIMITED BENEFITS ON A FIXED INDEMNITY BASIS. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS MAJOR MEDICAL COVERAGE) AND DOES NOT SATISFY A PERSONS INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). (******* Enrollment Agreement, 08/19/2022, pp. 4-5, emphasis added.)
  
  
  Further, consistent with our Company policy and the terms of your contract, you were afforded a full thirty (30) day period to review the products and cancel for any reason, at which time you could have received a refund of all monies paid.  However, you and your husband chose not to avail yourself of this right.  
  
  
  Similarly, with regards to your claim that your providers claims were improperly denied, we respectfully remind you that our Company does not have any involvement with claims nor any authority to review, process, and pay claims.  If you believe the claims were adjudicated in error, your recourse is to follow the plans appeal processes, which again must be directed to the carrier and/or their third-party claims administrator, as they are the entities that can address these issues.  
  
  
  Lastly, as detailed in our prior response and in the opening paragraph of this most recent communication, Adroit is willing to refund your most recent payment in the amount of $852.35 solely as a courtesy to you.  This should not be construed as an admission of any fault or liability on the part of Adroit Health Group, but instead represents a transaction and compromise of a disputed claim.  However, again because you have indicated that you may still have pending claims for this time period, the refund could result in denials for any claims for services during this period.  Therefore, we want to give you the option to first pursue any outstanding fixed indemnity claims with the carrier.  If you have no claims for this period and/or wish to forego any reimbursement for same, you may so advise Adroits ********************* at ****************************, referencing this BBB complaint.  Based on your request to proceed with the refund and your acknowledgement of the potential claims impact, we will be happy to issue a refund of your October-2023 payment.
  
  Should you have any further questions, please feel free to contact Adroit Health Groups ********************* via e-mail at ****************************.   
  

  Customer response

  09/06/2024

  I am rejecting this response because:   To whom it may concern,
  
  
  While I do appreciate your prompt response in addressing my grievances with your companies product, Im greatly disappointed at the lack of concern in regard to the representation and sale of those products to consumers by third-parties. Id hoped that in alerting you of such misrepresentation your company would have taken the necessary action to further assess the situation before denying any fraud or responsibility. Strata/Adroit Health Group does indeed have a responsibility to its consumers to comprehensively identify, *****, and mitigate possible risk potential with regard to the representation and sale of your products by third parties as part of your due diligence. Therefore, I do believe there is a degree of responsibility that should be addressed on behalf of your company. 
  
  
  Although I can understand why you would include the enrollment contract as evidence of tranperency, I made it very clear when I filed my complaint that the contract was NOT signed in good faith. The product was undoubtedly misrepresented to us by the third party individuals selling your product. And as I also pointed out, our point of sale transaction was processed and collected by Adroit Health Group in June of 2022 and continued monthly until November of 2023 when we cancelled. You listed the contact signature as August of 2022, an obvious discrepancy as the payment was in fact processed in June of 2022 two months prior to the date you have listed as the contact date. Although you emphasize in your response what the contract coverage parameters are, my husband and I both do not recall those parameters ever being disclosed verbally, in plain English, in real time, over the phone during the point of sale. Further more, I do not agree that signing a contract in real time via a text message link as adequate time to review or understand the parameters of what is being signed, especially when the product have not been represented truthfully. Also, with regard to the patient portal link information being mailed to us to access the contract as evidence of disclosure, I would like to point out again that we enrolled in a short term medical plan prior with no major issue, so when presented with another policy (Impact Policy) framed as similar by the agent in June of 2022 ( using misleading language such as  PPO, A great option for health families, 70/30%) we had no reason to suspect otherwise. 
  
  
  Misrepresentation alone IS considered grounds to invalidate the contact. While I can understand why you would include the above stated items as evidence of disclosure, Ill remind you that none of this was disclosed or understood at the point of sale over the phone. We were clearly taken advantage of and sold a policy that did not deliver what was promised. Although I may have noted minor changes in the begining, nothing to the degree that would alert me to the serious lack of coverage for our family until months after and well outside of the 30 day cancelation period. Had it not been for my shoulder injury in April of 2023 and my sons broken arm in May of ***************************************************************** monthly premiums for what we thought was major medical insurance but was in fact nothing more than limited and discount coverage at best. 
  
  
  I would like to yet again note that we did not start to receive balance bills until months after the ORIGINAL service dates of ****** **** and June of 2023 (specifically October of 2023 for myself and November of 2023 for my son). All of which were billed during the covered period between June of 2022 and November of 2023. Those bills were the FIRST MAJOR indication that there was a lack in coverage, hence the cancellation in November of 2023. Although concerned with the amount of money we owed in back billing, we did not understand the scope of how truly misinformed we were until August of 2024 with the notification of outstanding bills and discovery of MORE pending bills we currently face. All from the covered period of June 2022-November of 2023 for which we thought we had purchased major medical coverage, but clearly was not. 
  
  
  Im saddened at your ***** presumption of fairness as the lack of which has undoubtedly been made clear. I am greatly disappointed at the unwillingness of Adroit/Strata Health Groups to accept any accountability whatsoever. While I do not believe your company had any direct malicious intent towards me, I am appalled at the lack of empathy expressed in your response as your company did in fact benefit from the misrepresented sale of the Impact policy to usregardless of who sold it. I do believe that it is your companies responsibility to comprehensively assess third party risk by those representing and selling your products as part of your due diligence to ensure that they are being represented truthfully and responsibly to consumers. Therefore I feel we have grounds to ask for a full refund in the amount of $13,951.65 for the monthly premiums billed during the period of June 2022 - November of 2023 for which we were sold, and enrolled in a policy that was falsely represented and for which Adroit Health Group accepted payment for. 
  
  
  Furthermore, in an effort to be transparent I would like to disclose that 
  any error on billing/notification has been addressed with the medical and hospital billing departments respectively and all parties have been made aware of the current situation. All grievances with the agency and individuals involved in the sale have been addressed in separate complaints that have been filed with the appropriate agencies both on a states and federal level. 
  
  
  I sincerely hope that these grievances are taken seriously and that we can work together to find a reasonable solution. 
  
  
  Best, 
  ***************************;
  
  

   

  Attachments:

  22.pdf

  
  

  Customer response

  09/11/2024

  To whom it may concern,
  This dispute with Adroit Health Group/Strata Health Group has not been settled. 
  Per ****************************Duration Health Insurance Coverage Act (215 ILCS190) section 15 (effective February 1, 2019) clearly states in section c that the bold faced typed disclosure statement MUST be read aloud over the phone to protect the purchaser. THIS WAS NOT DONE. We were mislead by third party sales to believe we were purchasing full healthcare, which we in fact did not. This is a clear violation of that law. Im asking for a full refund of all premiums paid for the Impact Health Plan we were sold not in good faith and were enrolled in from June 2022 -  November 2023. 

  
  (215 ILCS 190/15) 
      (Section scheduled to be repealed on January 1, 2025) 
      Sec. 15. Disclosure requirements.  
      (a) A health insurance issuer that offers short-term, limited-duration health insurance coverage to be delivered or issued for delivery in this State shall, in addition to all other documents required, including, but not limited to, the policy, the certificate, the membership booklet, and a description of appeal and external review rights, deliver an outline of coverage to an applicant for or an enrollee in short-term, limited-duration health insurance coverage delivered or issued for delivery in this State.
      (b) Any short-term, limited-duration health insurance coverage policy that is delivered or issued for delivery in the State shall display prominently in the policy, any application, sales, and marketing materials provided in connection with enrollment in such coverage, and the outline of coverage for such coverage, in at least 14-point, bold type, the following: "NOTICE: THE SHORT-***** LIMITED-DURATION INSURANCE BENEFITS UNDER THIS COVERAGE DO NOT MEET ALL FEDERAL REQUIREMENTS TO QUALIFY AS "MINIMUM ESSENTIAL COVERAGE" FOR HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT. THIS PLAN OF COVERAGE DOES NOT INCLUDE ALL ESSENTIAL HEALTH BENEFITS AS REQUIRED BY THE AFFORDABLE CARE ACT. PREEXISTING CONDITIONS ARE NOT COVERED UNDER THIS PLAN OF COVERAGE. BE SURE TO CHECK YOUR POLICY CAREFULLY TO MAKE SURE YOU UNDERSTAND WHAT THE POLICY DOES AND DOES NOT COVER. IF THIS COVERAGE EXPIRES OR YOU LOSE ELIGIBILITY FOR THIS COVERAGE, YOU MIGHT HAVE TO WAIT UNTIL THE NEXT OPEN ENROLLMENT PERIOD TO GET OTHER HEALTH INSURANCE COVERAGE. YOU MAY BE ABLE TO GET LONGER TERM INSURANCE THAT QUALIFIES AS "MINIMUM ESSENTIAL COVERAGE" FOR HEALTH INSURANCE UNDER THE AFFORDABLE CARE ACT NOW AND HELP TO PAY FOR IT AT WWW.HEALTHCARE.GOV.".
      (c) Any individual selling a short-term, limited-duration health insurance coverage policy in this State in face-to-face or telephonic sales interactions must read out loud the disclosure in subsection (b) to a prospective purchaser. An entity selling a short-term, limited-duration health insurance coverage policy in ******** must display the disclosure in subsection (b) on the webpage where a prospective purchaser would purchase coverage.

• Initial Complaint

  08/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Hello,** was laid off of work and had to obtain health care coverage for my family. ThriveHealth STM was the health care coverage my past employer suggested that I use as well as the State of Arkansas.Shortly after I was laid off (~4 months) I became very ill, after verifying who I could see with ThriveHealth STM I was diagnosed with Cancer (appendiceal mucinous neoplasm). It did take several tests to figure out what the cancer was, and all of it was new testing and diagnostics. I had surgery in November 2023 to have the cancer removed and am medical rest for 12 months and waiting on disability as the cancer effected many organs and I had to have many of those organs completely removed as well having chemotherapy. Finally I am now receiving bills from *******************, ****************************** and Hot Springs Radiology with large amounts of patient balance for the medical treatment I received.ThriveHealth STM covered $3,409.28 leaving me with a total amount due of $35,449.17 I have tried to call ThriveHealth several times an most of the time I wait on hold for 2+ hours and then they disconnect me, or I leave my call back number and they never call me back. I was able to finally get ahold of someone today and they said that they could only look at 2 of the date of services when I have 16 I need to talk with them about. I paid all my premiums and now the health insurance company is refusing to help pay for my medical bills.

  Business response

  08/20/2024

  Dear ******************,
  
  Thank you for making Adroit Health Group (Adroit) aware of your unsatisfactory experience with the payment of your health care bills.  Unfortunately, Adroit is not in a position to assist you.  We have no record of any account corresponding to the (i) name, (ii) address, (iii) telephone number, or (iv) e-mail address that has been provided in your complaint.  We have specifically searched for an account using your last name (*******) as well that of the surname in the e-mail address you submitted (*********).  Based on your complaint, we have also searched for records of both a ******* and a ********* in both ******* and ******** and have been unable to locate any matching account.  Likewise, there is no record in our system of anyone having either your telephone number or e-mail address.
  
  Further, at no time has Adroit ever sold a ThriveHealth STM product on our platform.  It is respectfully suggested that you may have identified the wrong party in your complaint.  
  
  However, if you believe the information reported in your initial complaint is in error (such as, perhaps you purchased a different plan that was, in fact, sold through Adroit) or you are not the designated account holder (but perhaps instead a beneficiary of someone who does have an Adroit account), please feel free to contact Adroits ********************* at ****************************, and we will be happy to investigate further and respond to your complaint.  Likewise, if you believe our research is in error, kindly e-mail ****************************, and provide the Adroit membership identification number for the account and we will follow up as soon as possible.
  
  Lastly, please note that if you have had claims denied by any insurance carrier, you generally have certain appeal rights; but these rights are often time-limited, so you are encouraged to please follow up as soon as possible.  
  
  Best regards,
  *************************
  General Counsel & Chief Compliance Officer

• Initial Complaint

  08/13/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  I responded to what I believed was a message from my health care provider to help me find health insurance.I ended up purchasing what I believed to be a health insurance policy that was in network with my provider.Cleveland Clinic, my health care provider informed me that this was not insurance and that I could not use this policy to cover my health care costs.When I tried to address this with Adroit Health Group, it was very difficult to get a representative to discuss it with **** believe that I am the victim of a health insurance scam. Especially after doing some online research on Adroit Health Group.They have an F rating with the BBB, and there are many accounts online of other people who feel like they were scammed into purchasing health insurance that was not what they thought it was.I would like the money I payed them refunded.

  Business response

  08/15/2024

  ********************,

  Thank you for making Adroit Health Group, LLC (Adroit or the Company) aware of your dissatisfaction with the **************** Medical Plan that you purchased through our Company.  As you may be aware, Adroit does not engage in any direct-to-consumer sales.  Rather, we are an independent marketing organization and general agency that makes certain insurance and non-insurance products available for sale by licensed third-party insurance agents through our enrollment and billing platforms.  These agents are not employed by our Company, and as such, we have no knowledge of what they may have relayed to you concerning this plan.  However, in order to ensure that prospective customers are fully aware of what they are purchasing, Adroit requires that all sales conducted on our platform be consummated through presentation and execution of a formal Enrollment Agreement.  Your Enrollment Agreement was signed on July 02, 2024, at 9:42 a.m.  At that time, you purchased a limited medical plan.  Your attention is called to the following, express disclosures in your signed Enrollment Agreement:

  1.  You understand that the insurance coverage that you are purchasing is an ACCIDENT AND SICKNESS HOSPITAL INDEMNITY PLAN underwritten by Federal Life Insurance Company. (******** Enrollment Agreement, 7/02/2024, p. 4, emphasis added)
  

  2.  THIS POLICY PROVIDES LIMITED BENEFITS ON A FIXED INDEMNITY BASIS. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS MAJOR MEDICAL COVERAGE) AND DOES NOT SATISFY A PERSONS INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). (******** Enrollment Agreement, 7/02/2024, p. 4, emphasis added)
  

  3.  You understand the plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment. (******** Enrollment Agreement, 7/02/2024, p. 4)
  

  4.  You understand that if you have a PRE-EXISTING CONDITION, the accident and sickness hospital indemnity benefits may not be immediately available for claims associated with this condition.  You understand specifically, if you have had care rendered or prescribed to you by a physician within the 12 months leading up to your effective date, you will have a waiting period for 12 months before any claims related to your condition will be covered. (******** Enrollment Agreement, 7/02/2024, p. 4, emphasis added)
  
  5.  You confirm that the details of the accident and sickness hospital indemnity plan have been explained to you by your agent, including the limitations and exclusions. (******** Enrollment Agreement, 7/02/2024, p. 4)
  
  6.  You understand that if there are any discrepancies between what the agent told you about the plan and what the actual policy states, that the policy terms will apply. (******** Enrollment Agreement, 7/02/2024, p. 5)
  
  Hence, you were advised in writing at the time of your enrollment that the plan you purchased was not comprehensive health insurance.  Additionally, by your own admission, you did in fact receive the fixed indemnity payment that was specified in your plan. Further, your statement that you purchased the limited medical plan to assist with your copd, diabetes , high blood pressure and high cholesterol which were presumably affecting you prior to the commencement of the plan would then trigger the pre-existing condition limitation of the plan and make services for those conditions ineligible for the fixed indemnity payment that you received.
  
  Adroit sincerely regrets that you found your **************** Medical Plan did not sufficiently meet your needs.  We note, however, that your plan was cancelled at your direction on August 12, 2024.  A copy of the cancellation confirmation that you were e-mailed (and which our records show you opened and read on August 12, 2024, at 11:39 a.m.) is enclosed for your reference.  Furthermore, because you were in the first thirty days of your plan, your cancellation entitled you to receive a refund of your charges.  We have confirmed that you were issued a refund of all charges on August 12, 2024, at 12:31 p.m.  A copy of the receipt evidencing this refund is also appended to this response for your records.  (We note that both the cancellation and refund predated the submission of your complaint with the Better Business Bureau.) Depending on your particular financial institution, it can take up to five (5) business days before the refund appears on your credit card statement;  therefore, if you have not seen the refund hit your account within the next week, please contact Adroits ********************* at ****************************, and we will be happy to follow up on your behalf.
  
  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer

• Initial Complaint

  08/09/2024

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Resolved

  More info

  Applied for info on Obamacare website for a QUOTE. Got a call from a "verified" insurance person. Was sold on a healthy group plan application with the option to cancel with a full refund if I decided to go another route. Was charged 7/13. Was told I have 30 days to cancel. I tried to cancel on 7/19, 7/22, and again 8/6. Was told every time I would get a confirmation notification email within 3 days and then would get my refund within 7. I have also followed up on email multiple times now. No cancellation notification and no refund. I am now being ghosted. I have spent hours on the phone.

  Business response

  08/12/2024

  Dear **********************,
  
  Thank you for making Adroit Health Group, LLC, (Adroit) aware of the challenges you have experienced with your account cancellation.  Our records reflect that the first contact Adroit received concerning your cancellation was an e-mail that you sent to our ****** Services team on August 08, 2024, after business hours at 9:50 p.m.  Immediately the following morning (August 09, 2024), your account was placed on a billing hold to prevent any further charges from being incurred, and your message was relayed to your agent-of-record to contact you to complete the cancellation.  A response e-mail was immediately sent to you at that time  indicating that a confirmation of cancellation would be provided within three (3) business days.  You acknowledged receiving this e-mail on August 09, 2024, at 11:06 a.m.  Ten minutes later (August 09, 2024, at 11:16 a.m.), you e-mailed again indicating that you had previously attempted to cancel on three occasions.  Again, Adroit has no record of any such contacts from you, although our system logs every call or e-mail we receive.
  
  However, our record does reflect a communication from your agent-of-record on July 17, 2024, at 9:35 a.m., requesting that we update your record to add an apostrophe to your name, change your e-mail address.  It appears that this change was undertaken pursuant to a request they received from you.  As a reminder, your agent-of-record is not an employee of our Company and works for a separate company that has a contract with Adroit to provide administrative services through our billing and enrollment platform. 
  
  Further, in the attachments submitted with your Better Business Bureau complaint, you provide screen shots of calls in July-2024, with the contact name of ******* Insurance Opt out by October.  The telephone number listed with that screen shot is, in fact, your agent-of-record and not Adroit.  Therefore, if these are the cancellation calls you reference in your complaint, you made them with your agent-of-record, who failed to follow up and notify Adroit of your desire to cancel the account. However, in your Enrollment Agreement and subsequent communications sent to you concerning your account, the correct contact information for Adroits ****** Services Team ************* or ********************** was provided to you.  Unfortunately, Adroit is unable to address requests that are not made known to us.
  
  Nevertheless, following receipt of your complaint, I confirmed that your account was fully cancelled, and I requested our ****************** to process a full refund of your charges (in the amount of $447.95) to your credit card.  A copy of the cancellation confirmation and the refund receipt are both enclosed with this response for your records. Please be advised that, depending on your particular financial institution, it can take up to five (5) business days before the refund may post to your account.  Please monitor your bank account and if you have not seen the refund within the week, you are free to contact our ********************* at ****************************, and we will be happy to follow up on your behalf.

  Adroit sincerely regrets that you encountered challenges in attempting to cancel the account; however, we respectfully suggest that your complaint is better directed to your agent-of-record.

  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer

  
  

  Customer response

  08/12/2024

  I have reviewed the business response and accept this resolution. Understood *now* that this was the 'middle man's' mess up, thank you very much for resolving it. 

• Initial Complaint

  08/08/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  on June 0f 2023 I bought a health plan for my copd,diabetes , high blood pressure and high cholesterol good and bad. So I would need CT scans, blood work done. The agent told me and my wife that they could cover me. First payment was ****** and the monthly payment would be ******. When I went to do my taxes for the year, I needed a 1099 to show I had insurance. I called my adroit health group and they said they didn`t do that. But when the ************** sent in a claim the underwriter wouldn`t pay the claim. So I called the adroit health back and they took the claim and sent it in. I got a paper from the underwriter and it said I didn't have that type of insurance I had accident and sickness insurance. but they sent me 50 dollars and I had to pay the rest of that ****. the *********** made a claim and the insurance payed nothing on that bill. Now I was told that I had health coverage but the agent lied to us just to get our money. It wasn`t primary , it was secondary insurance. So I called the agent back and they want to keep saying it was insurance but I was lied to of what kind of insurance it was. My wife was listening when I bought the insurance. I canceled the insurance in July of 2024. Now I don`t have insurance until I get ******** in Februaryof 2025

  Business response

  08/13/2024

  Dear Mr. ******************* you for making Adroit Health Group (Adroit or the Company) aware of your dissatisfaction with the ************ Medical Plan that you and your agent purchased through our Company in June-2023.  Please be advised that Adroit does not engage in any direct-to-consumer sales.  Rather, we are a business-to-business provider of administrative services that makes certain insurance and non-insurance products available for sale by licensed third-party producers, such as the sales agent with whom you dealt, using our enrollment and billing platform.  However, these sales producers are not employees of our Company, nor do we own or operate the agencies for which they work.  Our contracts with these producers, who are not exclusive to our Company, require that they provide accurate information to prospective customers concerning product benefits, exclusions and limitations, and associated costs.  
  
  Further, in order to avoid miscommunications, Adroit requires that all sales conducted on our platform be consummated by presentation and execution of a formal Enrollment Agreement.  The Enrollment Agreement contains important disclosures concerning all material aspects of the transaction, and specifically includes disclosures concerning product coverages and limitations.  In this particular case, the Enrollment Agreement was presented to you and signed by you on June 22, 2023, at 9:53 a.m.  Your attention is called to the following express disclosures in your Enrollment Agreement:
  
  1.  You understand that the insurance coverage that you are purchasing is an accident and sickness hospital indemnity plan underwritten by Federal Life Insurance Company. (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  2.  You confirm that the details of the accident and sickness hospital indemnity plan have been explained to you by your agent, including the limitations and exclusions. (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  3.  This policy provides limited benefits on a fixed indemnity basis. It does not constitute comprehensive health insurance coverage (often referred to as major medical coverage) and does not satisfy a persons individual obligation to secure the requirement of minimum essential coverage under the *************** Act (ACA). (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  4.  You understand the plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment. (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  5.  You understand that if you have a pre-existing condition, the accident and sickness hospital indemnity benefits may not be immediately available for claims associated with this condition.  (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  6.  You understand specifically, if you have had care rendered or prescribed to you by a physician within the 12 months leading up to your effective date, you will have a waiting period for 12 months before any claims related to your condition will be covered. (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  7.  There is no coverage for a pre-existing condition for a continuous period of 12 months following the effective date of a Covered Persons coverage under the Policy. (***** Enrollment Agreement, 6/22/2023, p. 6)
  
  8.  You understand that you have a free trial period of 30 days. During this trial period or free look, you can cancel this membership and receive a full refund excluding the onetime enrollment fee, as long as you have not used any benefits.  (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  9.  You understand that if after using the program, at any time you are not satisfied, you may cancel your membership, and your benefits will be terminated at the end of the billing cycle for which you were billed. You, then, will not be billed any further. (***** Enrollment Agreement, 6/22/2023, p. 4)
  
  10. You understand that if there are any discrepancies between what the agent told you about the plan and what the actual policy states, that the policy terms will apply. (***** Enrollment Agreement, 6/22/2023, p. 5)
  
  11.  I agree that I have a full and complete understanding of the products for which I am applying. (***** Enrollment Agreement, 6/22/2023, p. 12)
  
  12.  By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. (***** Enrollment Agreement, 6/22/2023, p. 13)
  
  Further, immediately after executing your Enrollment Agreement, you were provided a welcome e-mail and Member Portal notification that detailed how you could access all plan documents and materials, including the ************ Medical Plan member guide, which contains substantial disclosures concerning both the limited nature of the benefits you were receiving and the exclusions and limitations applicable to your limited medical policy.  For reference, a copy of the ************ Medical Plan member guide is enclosed with this response for your reference.  Our records indicate that you accessed the Member Portal on at least seven (7) occasions, and therefore had ample opportunities to review these materials.  
  
  We also note that you purchased the most inexpensive plan available, the 100A plan, which as detailed in the Member Guide provides only a modest, fixed indemnity reimbursement of $50 per insured person per day for physician office visits along with a hospital confinement benefit of $100 per day per insured person.  Additionally, as noted in both the Enrollment Agreement (specifically, on page 4, as quoted hereinabove) and Member Guide (specifically, on page 3: There is no coverage for a Pre-Existing Condition for a continuous period of 12 months following the effective date of a Covered Persons coverage under the Policy), your policy did not cover pre-existing conditions for a period of 12 months following the effective date of your coverage, which would have been July 01, 2024.  
  
  Unfortunately, by your own admission, your COPD, diabetes, high blood pressure, and high cholesterol were in existence as of the time you purchased the ************ Medical Plan; and therefore, based on the plans Pre-Existing Condition limitation as detailed in the Enrollment Agreement and Member Guide, costs for services associated with these conditions would not have been covered under the plan until July 01, 2024.  Further, it does appear that you were properly reimbursed by the plan in the amount of $50 for the physician office visit that you submitted, which was in accordance with the terms of the plan.  With regards to any claims for lab services, these are not covered under the ************ Medical 100A Plan that you purchased and are available only under the 200-level and higher plans that are more expensive but offer expanded benefits.  Nevertheless, we should note that Adroit is not a third-party administrator for claims submitted to the ************ Medical Plan, and we have neither authority nor responsibility for claims review, processing, and payment; therefore, there could well be other reasons for the denial of claims submitted to the plan.  As a result, we would defer to the insurance carrier and/or its third-party claims administrator to address these specific issues in detail.
  
  Lastly, if you are interested in obtaining health coverage prior to your ******** eligibility in February-2025, you are urged to contact a licensed insurance agent of your choosing to discuss any options that may be available to you.  Please be advised that Open Enrollment begins on November 01, 2024, for calendar year 2025.
  
  Adroit regrets that you were not satisfied with the ************ Medical Plan that you purchased through our company.  However, as reflected in your Enrollment Agreement and accompanying plan materials, the particular policy that you purchased was limited medical insurance and was not comprehensive coverage.  You were provided this information at the time of sale, and it has been made continuously available to you at all times thereafter.  You were also afforded a full thirty (30) day period to review the plan and cancel without obligation.  Your first contact concerning your dissatisfaction with the account was July 17, 2024, which was over a full year from the time you initially purchased the plan.  I have confirmed that your account was cancelled at your request on July 31, 2024.  A copy of the cancellation confirmation is enclosed with this response for your reference.  
  
  Nevertheless, as a courtesy, this date I have requested Adroits ****************** to refund your last months payment of $335.90.  This refund shall not be construed, interpreted, or deemed as any admission of fault or liability on the part of Adroit Health Group, LLC, and its affiliates, but rather solely constitutes a good faith transaction and compromise of a disputed claim.  A copy of the receipt evidencing this refund is enclosed with this response for your records.  Please be advised that, depending on your particular financial institution, it can take up to five (5) business days before the refund is posted to your bank account.  If you have not seen this refund on your statement in the next week, please feel free to contact Adroits ********************* at *********************************************, and we will be happy to follow up further for you.
  
  Best regards,
  
  ******* *****
  General Counsel & Chief Compliance Officer

  Customer response

  08/13/2024

  I am rejecting this response because:   I was not told any the the things that they had numbered on their response. And the company put $335.90 in my checking account. The only think I was given by them was the cards.

  Business response

  08/14/2024

  Mr. *****,
  
  Thank you for your reply.  Please find enclosed herewith, the Enrollment Agreement that you were presented and signed on June 22, 2023, at 9:53:27 a.m.  We note that the Enrollment Agreement was signed utilizing a device that bore the internet protocol address of *************, which corresponds to your location in ********* All of the enumerated disclosures relayed in our previous response contain page references to where you will find those disclosures in your Enrollment Agreement.   You will also find your signature on page 13 of the Enrollment Agreement.  
  

  With regards to your new complaint that you were only provided member identification cards, please be reminded that immediately upon signing the Enrollment Agreement, you were sent a Member Portal Notification e-mail, which our system shows you opened and read on June 26, 2023, at 11:43 a.m.  A copy of the Member Portal Notification e-mail is enclosed with this response for your reference.  You are reminded that this e-mail notification specifically states, as follows:
  __________________________________________________
  Heres some important information about accessing your product information and important documents from the member portal. Please save this email so you can refer to it later.
  
  You have 24/7 access to important product information and program documents via the Member Portal. Your login instructions are listed below. Please register to use the Member Portal as soon as possible using the link provided. NOTE: Most product documents and important information is only provided electronically from within the member portal.
  
  If any of your product(s) enrolled include ID cards, digital ID cards are available in the member portal from the 'view and print' button next to the product name.
  __________________________________________________
  
  Lastly, we are pleased to learn that the voluntary refund we issued as a courtesy to you, as referenced in our initial response, was successfully credited to your account by your bank.  

  Please feel free to contact our ********************* should you have any additional problems with regards to your former account.
  
  Sincerely,
  ******* *****
  General Counsel & Chief Compliance Officer

  Customer response

  08/14/2024

  I am rejecting this response because:   On my phone and laptop, If I open a attachment from a e-mail it saves the attachment. Now I seen you said that you seen that I opened it. But it isn`t on my computer or my phone. This company are just crooks, I looked into other insurances after I left them and was told my copd stops me from getting any insurance. They new and they lied to me about the coverage. 

• Initial Complaint

  07/29/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I tried to cancel my insurance in June and they said i would get a confirmation email. I did not get an email and they are trying to charge me again for something I have already tried to cancel twice. They are committing fraud

  Business response

  07/30/2024

  Dear ****************,

  
  Thank you for making Adroit Health Group (Adroit) aware of your concerns regarding your cancellation.  Our records reflect no communication from you in June of 2024. Rather, the first communication we show you made to Adroit in regard to cancelling your account was on Friday, July 26, 2024. It is possible that you may have previously contacted your agent-of-record regarding this request, but we have no record of this. However, immediately upon receiving your cancellation request, your account was placed on a billing hold to prevent you from incurring any further charges, while the cancellation process ran its course.  I have this date confirmed that the account has been completely cancelled.  A copy of the cancellation confirmation e-mail is appended to this response for your reference.  If you have any further problems, please feel free to contact our ********************* at ****************************.  
  
  Sincerely,
  *************************
  General Counsel & Chief Compliance Officer

  Customer response

  08/05/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  07/19/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I got new Health insurance I told over the phone that meds will be covered, and everything will be too but will have co-pay's 85%, I found out from my pharmacy that they won't cover any of my meds I need which I was told they will but they lied to me which is illegal under the federal law so I canceled my insurance with the company which I haven't used the insurance but they won't give me my money back. I want my money back since I didn't get what I asked and told I was getting.

  Business response

  07/23/2024

  Dear ************,
  
  Thank you for making Adroit Health Group (Adroit) aware of the problems you encountered with the purchase of your NCE ************ Medical Plan.  Please be advised that Adroit does not engage in any direct-to-consumer sales.  Rather, our company serves as a general agency and independent marketing organization that makes certain insurance and non-insurance products available for sale by third-party sales producers through our enrollment and billing platform.  All sales on our platform are conducted by third-party contractors who are neither owned, operated, nor affiliated with Adroit Health Group.  However, our agreements permitting access to our enrollment platform require that the sales contractors provide accurate information to customers concerning products, exclusions and limitations, and associated costs.  To the extent this was not your experience, we sincerely apologize.
  
  In order to avoid confusion, we require all sales on our platform be consummated by providing the customer with an Enrollment Agreement that spells out all material terms and conditions of the sale.  The customer must review and agree to these terms before ever being charged, and the agreement along with all plan documents is made available to them continually thereafter through our online member portal.  It appears that your Enrollment Agreement was signed on June 28, 2024, at 5:06 p.m.  Therein, you were advised that the plan you were purchasing was not major medical insurance and that the only medication benefits that were being offered were for prescription discounts.  Because Adroit was not the sales producer, we were not privy to the discussions that you had with your agent.  However, the Enrollment Agreement clearly specifies that: 
  
  (1) Plan Benefits;  Hospital Confinement ************************ Visit ************************************* Visit *************************************** Visit Benefit, Emergency Room Benefit. (page 2); 
  
  (2) ************************************* Services and Discounts:   Prescription Discount Benefits (page 3); 
  
  (3)  [T]he insurance coverage that you are purchasing is an accident and sickness hospital indemnity plan underwritten by Federal Life Insurance Company (page 4); 
  
  (4) This policy provides limited benefits on a fixed indemnity basis. It does not constitute comprehensive health insurance coverage (often referred to as major medical coverage) and does not satisfy a persons individual obligation to secure the requirement of minimum essential coverage under the *************** Act (ACA) (pages 4-5); 
  
  (5) [T]he plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment. (page 5).  
  
  Likewise, even if prescriptions had been covered under the plan, which the materials reflect was not the case, the Enrollment Agreement and plan materials also specify that there would be a significant waiting period for anything associated with a pre-existing condition.  There is also no reference in any plan materials to an 85% co-pay;  and instead, the plan documents clearly define that the benefits payable under the NCE ************ Medical Plan consist of a fixed indemnity benefit, which pays a set amount (based on the indemnified service received) directly to the beneficiary.  There is a PPO network that allows for you to receive discounted services under the plan, but this is not a requirement of coverage;  and instead, the use of the provider network allows for your fixed indemnity benefit to stretch farther.  
  
  It is certainly possible that these matters were not adequately explained to you by the sales contractor with whom you dealt.  For this reason, we have been in contact with her agency to express our concern and request additional training be conducted with her and other staff in their agency concerning such matters.  In the meantime, it appears that you have taken advantage of our thirty (30) day free-look period that allows you to review your account for the first thirty days and cancel for any reason.  Enclosed please find a courtesy copy of the cancellation confirmation that shows your account was terminated upon your request.  Additionally, I have this date confirmed that a full refund of your charges in the total amount of $416.95, has been issued by Adroits Billing Department.  A copy of the receipt evidencing this refund is also appended to this response for your reference.  Please be advised that, depending on your particular financial institution, it can take up to five (5) business days before a refund is reflected on your bank statement.  If you have not seen the refund hit your account by next week, please feel free to contact our ********************* at ****************************, and we will be happy to follow up on your behalf.  
  
  We sincerely regret that you did not find your sales experience and the NCE ************ Medical Plan suitably meet your familys needs.  
  
  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer
  

• Initial Complaint

  07/15/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  My husband and I went through an insurance agency to purchase healthcare today. We spoke to the agent on the phone to seek the best coverage to suit our needs. We ended up with coverage from Adriot Health. The agent was extremely misleading. We were under the impression that the insurance we signed up for was for full coverage. We explained to the insurance agent that we needed coverage for labor and delivery as well as for our unborn child to cover any medical expenses that *** occur after giving birth. He had assured us that labor and delivery would be covered as well as any needs the child will need after birth if necessary. The last two things on the LONG list of items that were not covered were : Childbirth and Delivery and wellbaby care of newborn infant. We also wanted to make sure that this health insurance was accepted by our OBGYN and primary care doctor. He also "looked it up" while on the phone with us and relayed to us that it was in fact covered, only to find out he completely lied about everything. Nothing we needed coverage for was included in our plan, and our doctors do not accept this type of insurance if this company is even real. Now, I have also seen this business responding to others saying that everything is clearly stated in the paperwork, however the paperwork explaining all of the coverage was not given to us until AFTER we had already paid and given all of our information over. We have done our research online after feeling like we got scammed, where every other person who has dealt with this company also has felt mislead and like everything was a scam. We demand our money back or we will have no other option than to take this to court. How on earth can you scam an expecting family who is already struggling to find health insurance and stress about how to reverse this scam. We paid $712.85 in total- money we did not have to spend freely like this. Thank you for nothing. DO NOT TRUST THIS SCAM.

  Business response

  07/19/2024

  
  Dear Ms. ******************* you for making Adroit Health Group (Adroit) aware of your dissatisfaction with your purchase of the *** Health Plan that your husband made on July 15.  We regret that you found the sales representative to be misleading in his discussions with you, and we have relayed your concerns to his employer.  Please be advised that Adroit does not engage in any direct-to-consumer sales.  Rather, our company serves as an independent marketing association that makes certain insurance and non-insurance plans available for sale by licensed insurance agents using our enrollment and billing platform.  All sales on the Adroit platform are conducted by third-party contractors who are neither employed by nor affiliated with our Company.  Our agreements with these sales producers require that they provide accurate information to all prospective customers concerning products, exclusions and limitations, and associated costs.  To the extent you feel this was not your experience, we sincerely apologize.  Nevertheless, our Company endeavors to ensure that customers understand exactly what they are purchasing, and we do this by requiring that all customers receive a written Enrollment Agreement, which must be reviewed and signed in order to consummate the transaction.  Our records reflect that your husband received your Enrollment Agreement on July 15, 2024, at 3:37 p.m.  
  
  With regards to your specific complaints, we must respectfully disagree.  You have alleged that you and your husband, were under the impression that the insurance we signed up for was for full coverage.  Your attention is called to the following disclosures in your enrollment agreement:
  
  -  The *** plan is not a Major Medical or Comprehensive Coverage. The *** plan covers the preventive health services required by the **** 2713 (a) without any cost-sharing requirements. **************************** 07/15/2024, p. 2, original underlined for emphasis)
  
  -  This Plan does not cover benefits unless listed in the Schedule of Benefits, so please review that list carefully. **************************** 07/15/2024, p. 2, original underlined for emphasis)
  
  -  This group health plan is limited to covering preventive and wellness services as required by the Patient Protection and *************** Act as well as other benefits noted in the Schedule of Benefits, which describes the benefits covered by the Plan and how these benefits are covered, including information on copays, deductibles, and limitations. ***/VP LP sponsors this group health plan. **************************** 07/15/2024, p. 2, original underlined for emphasis)
  
  -  THIS IS NOT AN AFFORDABLE CARE ACT PLAN. THIS IS NOT QUALIFYING HEALTH COVERAGE ("MINIMUM ESSENTIAL COVERAGE") THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES.  **************************** 07/15/2024, p. 5, original capitalized for emphasis)
  
  -  I agree that I have a full and complete understanding of the products for which I am applying. **************************** 07/15/2024, p. 8)
  
  -  By electronically acknowledging this authorization, I acknowledge that I have read and agree to the terms and conditions set forth in this agreement. **************************** 07/15/2024, p. 8)
  
  Likewise, there were a number of additional, important disclosures that your husband specifically checked as understanding and agreeing to in the Enrollment Agreement, including the following:
  
  -  I agree that the membership program I enrolled in does not replace Major Medical, ************************** or Medical Disability.  . **************************** 07/15/2024, p. 2)
  
  -  I further acknowledge and understand that some plans may have waiting periods for benefits related to pre-existing conditions and a thirty (30) day waiting period for sickness claims. . **************************** 07/15/2024, p. 2)
  
  Because we were not a party to the discussions held between you and your sales agent on July 15, 2024, we are unable to address what you may have been advised about childbirth, well-baby, and OBGYN services.  However, we do note that both your Enrollment Agreement and plan materials note that there is both an exclusion for pre-existing conditions and a thirty- (30) day waiting period for coverage of certain services, as well as an express exclusion for neonatal intensive care (see page 2 of your Enrollment Agreement), which may or may not have played a role in any coverage considerations.  Nevertheless, we are pleased that you were able to review the Schedule of Benefits provided to you and discovered that the plan did not sufficiently meet your needs.  Unfortunately, we are unable to provide all plan documents for every product prior to sale; however, all disclosures of material aspect of each product that has been approved for the respective carriers and vendors responsible for each, are included in the Enrollment Agreement materials that you do receive prior to sale.  For this reason, we also extend a thirty- (30) day review period during which time you are free to review all plan documents, member guides, and other materials concerning your products, and if dissatisfied for any reason, you are entitled to cancel without obligation and receive a full refund.  
  
  We are pleased to report that, following your request to cancel the account, your account was, in fact, closed the same date your request was received by the sales agency.  A copy of the cancellation notice dated July 16, 2024, is appended to this response.  Additionally, we note that your account was refunded in full in the amount of $712.85 this same date.  A copy of the receipt evidencing this refund is enclosed for your reference.  Please be advised that, depending on your financial institution, it can take up to five (5) business days before the refund that has been issued is reflected on your bank statement.  In the event you have not seen these funds hit your account within the next week, please feel free to contact my office directly at ****************************, and we will be happy to assist you further.
  
  Again, Adroit sincerely regrets that you found the sale was not to your liking and that the *** Health product did not sufficiently meet your familys needs.  We hope that you have found other coverage that better suits you and your family.
  
  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer
  

• Initial Complaint

  07/15/2024

  Complaint Type:

  Delivery Issues

  Status:

  Answered

  More info

  Date of transaction: 02-15-2024 Amount paid: Believe to be around $900 Committed to provide: comprehensive insurance, with verifying that all my current providers were within network and the prices I could expect for all my current medications Nature of dispute: deceptive sales tactics, misleading information and no transparency regarding actual product. The contract for the plan is not made available for the consumer to review until after enrollment. I know Adroit/Strata states that all refunds are guaranteed if you cancel within 30-days, but these contracts are not sent directly to you and are available to you on the portal. But with the language used with the agent you are under the assumption that you have purchased a comprehensive plan that is ACA compliant, which one does not realize is completely false until after visiting a provider. Attempting to cancel the plan proves another headache as wait times on average are over 100 minutes, calls being dropped and when finally reaching a live agent one is met with pressuring language and who employ various antics to keep you from dropping the plan. Constantly referring to the portal where one can access all providers who accept this "plan", the list of providers is a joke. Adroit/Strata has made no attempts to resolve this issue due to my cancellation being outside of the 30 day window, so they are off the hook. This company assumes no liability for the tactics used by the agents who speak directly with the consumer stating that they are third-party contractors and are no way affiliated with Adroit?? Very confusing and infuriating. I have noted that Adroit does require however that they provide accurate information to prospective customers concernin product offerings, exclusions and limitations, and associated costs. None of which were disclosed during initial call with the agent

  Business response

  07/25/2024

  Dear Ms. **********,
  
  Thank you for making Adroit Health Group (Adroit) aware of your dissatisfaction with the sale of your Impact Health Plan last January.  You have relayed that you believe the terms of the plan were misrepresented to you, which is an allegation we take very seriously.  Please be advised, however, that Adroit does not engage in any direct-to-consumer sales.  Rather, our company is solely a general agency and field marketing organization that makes certain insurance and non-insurance products available for sale by third-party insurance agents who are neither owned nor operated by Adroit nor otherwise affiliated with our Company.  These sales agents typically (although not always) conduct sales through any number of companies, including but not limited to Adroit.  However, our agreements with these third party contractors require that they provide accurate information to prospective customers concerning products, exclusions and limitations, and associated costs.  Furthermore, prior to any sale being consummated on our platform, Adroit requires that the sales agent provide the customer with a written Enrollment Agreement that contains all material terms and conditions of the transaction.  You were provided your Enrollment Agreement on January 31, 2024, at 6:37 p.m.
  
  Despite your contention that you were never made aware that the product you were purchasing was not ACA-compliant nor comprehensive insurance, your attention is called to the following express disclosures from your Enrollment Agreement dated January 31, 2024:
  
  1. The Impact Health Limited Medical Plan includes access to the MultiPlan *** *************** LIMITED BENEFIT MEDICAL PLAN IS NOT A COMPREHENSIVE MAJOR MEDICAL PLAN, NOR IS IT INTENDED TO REPLACE A MAJOR MEDICAL PLAN. The plan is intended to provide members,  and their covered dependents,  with BASIC INSURANCE COVERAGE THAT IS CAPPED AT SPECIFIC AMOUNTS FOR SPECIFIC SERVICES. (Chiczewski Enrollment Agreement, 01/31.2024, p. 3, emphasis added)
  
  2. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. (Chiczewski Enrollment Agreement, 01/31.2024, p. 3, emphasis original)
  
  3. This policy provides limited benefits on a fixed indemnity basis. IT DOES NOT CONSTITUTE COMPREHENSIVE HEALTH INSURANCE COVERAGE (OFTEN REFERRED TO AS MAJOR MEDICAL COVERAGE) AND DOES NOT SATISFY A PERSONS INDIVIDUAL OBLIGATION TO SECURE THE REQUIREMENT OF MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT (ACA). (Chiczewski Enrollment Agreement, 01/31.2024, p. 4, emphasis added)
  
  4. You understand the plan shall pay the benefit amounts listed in the Schedule of Benefits that will be included in the membership materials sent to you upon enrollment.(Chiczewski Enrollment Agreement, 01/31.2024, p. 4)
  
  Given that you were only playing $247.70 per month for your limited medical plan, which was clearly disclosed to you at the time of sale, one must question the reasonability of your belief that you were purchasing comprehensive health insurance.  Rather, the amount you paid was commensurate with the limited benefits that you received, which we note did, in fact, include coverage for physicians office visits, hospital confinement benefits, and emergency room benefits.  
  
  Moreover, your alleged dissatisfaction with the listing of providers who accept the plan is misplaced.  As expressly noted in both your Enrollment Agreement and the plan documents applicable to your Impact Health Plan, usage of the *** network does not affect your coverages under the plan.  Rather, the plan you purchased is a faxed indemnity benefit plan that provides a set rate of reimbursement that is paid directly to you upon receipt of covered services.  While a *** network is available to help you find reduced costs against which your fixed indemnity benefit may be applied, that network does not affect whether or not the benefits are ultimately paid to you.  
  
  Further, consistent with our Company policy and the terms of your contract, you were afforded a full thirty (30) day period to review the products and cancel your account.  You were provided access to all plan documents through our electronic member portal as of the moment you executed your Enrollment Agreement, and our records reflect that you logged into the member portal on multiple occasions.  You did, in fact, cancel your account on May 22, 2024.  While you were outside the thirty (30) day cancellation window, and therefore not entitled to a refund, our records further reflect that you still received a refund of both your April and May payments whereas your first contact about the plan to either our Company or your sales agent occurred in April. 
  
  Lastly, we have thoroughly investigated your complaint about experiencing long wait times when attempting to discuss your account. Our account records indicate that on at least six (6) occasions, you called in directly to the agent-of-record, who again, is not an employee of Adroit.  Likewise, you were transferred by our Company to the sales agency for other inquiries on several other occasions, particularly where the nature of the call necessitated involvement of your agent-of-record. Consequently, we are unable to respond as to whether there was any delay or other difficulty in speaking with the agency.  However, with regards to incoming calls directly to Adroit, we have identified none with excessive wait times or hold times.  Furthermore, our ********************* conducted an internal audit of call wait times on July 16, 2024, and found that the average wait time to speak to an Adroit ****** Services representative was only 59 seconds. 
  
  Nevertheless, Adroit can confirm that your account was indeed cancelled at your request on May 22, 2024.  A copy of the cancellation notice is provided herewith for your reference.  Additionally, we can confirm that you, in fact, received a refund of two (2) months charges, in the amount of $247.70 each on July 09, 2024, which we note was prior to your BBB complaint.  Copies of the receipts evidencing these refunds are also appended to this response. 
  
  We regret that you did not find your Impact Health plan to suitably meet your needs and that you were dissatisfied with the sales process with your third-party agent and subsequent communications.  However, as reflected above, we believe that you have been treated fairly and in full accordance with the terms of your contract and applicable law.  It is sincerely hoped that you were able to find alternate insurance coverage that is cost-effective and better meets your familys needs.
  
  Sincerely,
  
  *************************
  General Counsel and Chief Compliance Officer

  Customer response

  07/25/2024

  I am rejecting this response because: 
  

  There were no attempts by the company to inform me about the refunds. Additionally there are no transaction records with my bank statements showing that the refunds were ever processed and approved.  

  Business response

  07/26/2024

  Ms. **********,
  
  Thank you for your follow-up inquiry.  It appears that no additional communication was sent to you with regards to your two refunded payments because you had initiated a chargeback with your bank, and therefore, you presumanly knew that the refunds were at issue. 
  
  With regards to the status of those repayments, you will need to check with your financial institution as we do not have visibility into their internal processes nor the status of how and when such payments are cleared within their system.  However, I have been advised that it can take up to five (5) business days for the refunded payments to be posted to your bank account, although this time frame varies depending on your particular financial institution.  Therefore, you should find the refunds reflected on your bank statement sometime between July 09-July 16, 2024.
  
  The following is the transactional information we were provided regarding your two (2) refunded payments:
  
  REFUND #1
  Type:                          Visa
  Method:                     *************************** xxxxxx9293 08/2027
  Date/Time:                 July 9, 2024 at 4:06 PM
  Settled:                      July 9, 2024
  Transaction ID:           F8EB561FD186BB833461A0BB2C2AE02C
  Transaction Status:    Approved
  
  REFUND #2
  Type:                           Visa
  Method:                      *************************** xxxxxx9293 08/2027
  Date/Time:                  July 9, 2024 at 4:05 PM
  Settled:                       July 9, 2024
  Transaction ID:           F8E38E6DC6472205F9A8C953AF4F5AF2
  Transaction Status:    Approved
  
  Again, we are providing copies of the refund for your reference.  Please find both refund receipts appended to this response.  You should be able to utilize these transactional details to follow up directly with your bank.  Should you have any additional questions, please do not hesitate to contact Adroits ********************* at ****************************.  
  
  Best regards,
  
  *************************
  General Counsel & Chief Compliance Officer

*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. ↩