ComplaintsforEmployer Direct Healthcare, LLC

• Initial Complaint

  08/04/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I had paid my deductible of 1600 back in January to get an endoscopy. I was told that their policy stated that this would flow over to my primary insurance no later than 90 days. I have been patiently waiting but we are now way past 90 days, in fact we are approaching 8 mths and nothing has been done. When I call to speak to someone there response is that a different team handles that with no sign of a resolution in site. I would like my deductible credited to my insurance ASAP!

  

  Business response

  08/19/2024

  Thank you for reaching out to us. We're sorry this issue hasn't been resolved for you yet. Our team is currently working to get in touch with Anthem for an update on their end but have not heard back yet. The team let me know that they have also contacted you to share more details about the actions we are taking to get this resolved. We value your feedback and we are actively working to get this resolved as soon as possible.

• Initial Complaint

  05/02/2024

  Complaint Type:

  Product Issues

  Status:

  Resolved

  More info

  I was scheduled for an upper endoscopy for ******* 25th,2024. I was told by a representative for the business that I would need to pay $1651.02 prior to having the procedure because my deductible had not yet been met for this year. On ******* 22nd,2024 I paid $500. On ******* 24th,2024 I paid the remaining $1151.02.After the procedure the business never informed my health insurance company, ********** Blue Shield, of the payments. Therefore, I never got credit towards my yearly deductible for the money I paid. Other claims have since been processed, and my insurance is holding me responsible for other ***** that they are now crediting towards my deductible. I have been asking the business since ******* to report the amount paid to my insurance so I will get credit for the money I paid. They have failed to do so. They keep telling me they are working on it, but even after the claim was escalated to their operations department no progress has been made.At this point I have overpaid towards my deductible. I want a refund for the money I paid to Surgery Plus, as they are not entitled to keep my money because I have since met the majority of my $1800 deductible due to other claims and doctor ***** that have been filed in a timely manner. I need the excess money I paid back. Being out that much extra money is a financial hardship on me. I had surgery recently and have not yet been released to go back to work. Surgery Plus claims they submitted the information to my insurance, but I spoke to a representative at ********** Blue Shield again yesterday and they told me they never received this claim from Surgery Plus. ********** Blue Shield has informed me that the refund will have to come from Surgery Plus. I have made Surgery Plus aware of the issue via numerous phone calls and e-mail. They acknowledge a mistake has been made but have not resolved the situation in the over 3-month long period since the payments were made.

  

  Business response

  05/06/2024

  Thank you for your message. Our team is aware of this situation and is working closely with your insurance carrier to resolve it and issue you a refund. A Care Advocate will contact you this week to share an update. 

  Customer response

  05/10/2024

  I am rejecting this response because:   
  the business promised to reach out this week. 
  I have not heard from any of their representatives. I have not received any written communication from the business via postal service or e-mail. 
  The business is once again not keeping their promises. 
  I will be satisfied when they actually take notable action.
  Due to how long the situation has been going on I will not accept any more hollow promises. 

  

  Business response

  05/15/2024

  Thank you for your response and sharing more about your experience. Our Care Team has confirmed that they have been in touch with you and shared details of the refund you can expect. They will continue following up with you until we have confirmed you received your refund.

  Customer response

  05/15/2024

  I have reviewed the business response and accept this resolution. 

• Initial Complaint

  03/04/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I signed up with Surgery Plus in October 2022, for nose surgery. When signing up for the program, I was told about the incentive and the cost to me would only be the collection of my whatever is left from my health insurance deductible at the end of the surgery year. I am due to see the a provider this month March for a consultation, and with possible surgery in 1-3 months. But when I called Surgery Plus on 3/2/23 to ask about clarification on what I will owe after the surgery, just doubling checking that I will just owe the residual amount of my deductible (as advised at the beginning), but I was now told I owe the residual amount of my out-of-pocket amount and not only the deductible. This is not right, and I was mislead.That being said, I kindly request that Surgery Plus honors what they advised and I would only be responsible for the deductible residual amount, and not the out-of-pocket amount. Also please see written promise of this from my care advocate. Regardless, of what your contract is with my employer...I was promised this agreement and I expect Surgery Plus to honor that.

  

  Business response

  03/07/2023

  We appreciate your reaching out to inform us of the additional support that is required. We are reviewing all of the information that we have on file so that we can find an immediate resolve for you.
  Our team will be connecting with your directly to address your questions and concerns.
  
  Team EDHC

  Customer response

  03/08/2023

  (The consumer indicated he/she DID NOT accept the response from the business.)
  I appreciate the response. But after many phone calls, emails, etc. I have never received any type of confirmation on my patient responsibility. I was promised only the residual deductible will be collected, and not my out-of-pocket *** at the end of the year.
  
  That being said, I kindly request a phone call and a confirmation that in fact surgery plus will do what they promised. This has been a complete mess.
  
  Thank you.
  See Attachment/File: Gmail - RE_ External to EDHRE_ SURGERY PLUS- Coverage.pdf

• Initial Complaint

  02/20/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I was directed to Surgery Plus through my employer, ***************** Due to the fact if a surgery is spine, nerve, or bariatric related they MUST go through the Surgery Plus program or they will not pay anything. I was told I would be set up with a physician that I would be able to travel by car or plane to any location with my caretaker and expenses provided on a card for gas and food. These appointments we had to take on ourselves because they set me up with a surgeon who is too rural to fly me to. I asked about a rental car, they said I had $158.00 on my card could use for that. I asked ****** if she were high to ****** the cost of a flight ticket let alone two. There was also a mishap between the communication of the hospital staff who discharged me. I was supposed to be given Oxycodone after they released me. The medicine bottle they filled was Hydrocodone. Which I know is a different medicine than prescribed. I didn't get my medicine I needed to successfully control the pain until more than 24 hours after my surgery, back in ******** at my local pharmacy in **************. When we were leaving for my surgery my card had not been loaded with any funds. I tried contacting my case worker *************** but she would not return my calls. She apparently flaked out. This is all stuff in their contract that they promise. They called the day I had just had surgery, the following day and said had loaded my card. The refused to pay me back the gas I was out to get there, I have the receipt. They have lied and failed 110%. Their excuse was it was because we left over the weekend. That's no excuse, that's a case workers job. I have suffered and cried my eyes out. I had to do an emergency room trip last week due to healing complications which is post op. They are refusing to pay it, even though I wouldn't have had to go had it not been for the less than adequate service I received.

  Customer response

  02/21/2023

  I have another case filed with all the info but here:
  It's *************************** (*******) and yes I know I'm on LOA currently, but I need help! This Surgery Plus program is not doing anything they are supposed to be doing and basically left me to do it myself. They have failed me 110% of this experience. Is there anyone in HR that can step in on this? I'm getting ready to contact an attorney, it's that bad.
  
  He's waiting for my return phone call now that I've spoken with ****** about how little they can do. It's supposedly been on recorded lines and emails saying different.
  
  They mentioned a telehealth visit for my pre-op and I'm having issues, I've gotta see him. But they won't provide me transportation there, no local airport near the facilities THEY MADE ME GO TO.
  
  I really need to speak with someone in HR or whoever is in charge of this supplemental insurance program. It's a joke and a failure.
  
  Looking forward to heading from you.
  ***************************
  
  
  
  
  
  
  
  
  
  
  

  

  Business response

  02/22/2023

  Dear ***************
  
  We have had our supervisor team reach out on multiple occasions both on the phone and within email to support in the resolution regarding your funds and to inform you that we have resolved this for you. You have indicated that you no longer want to be contacted, but please know that we will continue to support you with your remaining appointments, providing you with the funds required and setting up your remaining travel as required.
  
  Please do not hesitate to reach out directly to your Care Advocate if you required additional support.
  

  Customer response

  02/23/2023

  (The consumer indicated he/she DID NOT accept the response from the business.)
  I stated I did not want to speak to the same case worker as I had requested a call from a director 6 times and was never received. It was of no use to keep communicating with Mianna as until I reached out to human resources at Hyatt she was unwilling to do anything to assist. After ***** reached out to SurgeryPlus and threw a fit you agreed to get the plane tickets, 14 hours before departure time. After I had to argue with multiple emails for days that this service was indeed to be provided. In that time frame someone in family reached out and is allowing us to use their car to avoid having to fly.
  
  My point is, the case Advocate assigned is for you, they are to assist you
  
  My last Two case workers have both failed in the form of providing what they should in a timely matter not requiring the patient to reach out dozens of times to have to argue why they should get the benefits they are entitled to.
  
  If proof of the incident is required I have pictures of every email sent and the amount of effort in phone calls it took to get anything done.
  
  This program is provided to Hyatt employees so we don't have the stress and bother of getting everything lined up and taken care of while healing. That is the mission of the program through Hyatt as I was told from them, and Surgery Plus has failed in every aspect.
  
  They still have not reimbursed me a refund for the amount I was out on my previous trip for my actual surgery, only compensation offered on that was Surgery Plus offered to load more funds on their card which can only be used at appointments. I requested a refund to my debit card seeing as the funds came from my personal checking account and putting it back in their own account is absurd.
  
  If any photocopies are needed for proof I can provide.
  
  Note the screen shot included where asked for my husband's info, was responded to by a phone call telling me they could not fly me, ****** told me there were no flights available it was too local of an area.... after several calls and emails to *************** and my telling them they were available and times and such, even submitted screen shots of flight info they were gotten for us.
  
  Point is Surgery Plus did not want to assist me until I reached out to my corporate HR and got a totally different response as Mianna would not listen to what the patient (me) was saying and I had already been done wrong according to the service they state they provide so your experience is stress free. ***** agreed there is some way to reimburse me for what we were out rather than loading to their own prepaid card that's for use only when traveling for these appointments.
  
  What they describe as they are there to assist you and make sure you have a peaceful time after surgery to heal with no concerns, is a lie. Unless you have numerous hours to spend on phone calls and emails
  
  See Attachment/File: Screenshot_20230222-121311_Chrome

  Customer response

  02/23/2023

  ***Document Attached***
  More screen shots showing the amount of emails and stress this whole experience caused
  See Attachment/File: Screenshot_20230223-081656_Gmail

  Customer response

  02/23/2023

  ***Document Attached***
  
  See Attachment/File: Screenshot_20230223-082008_Gmail

  Customer response

  02/23/2023

  ***Document Attached***
  More photos of attempted contact over this
  See Attachment/File: Screenshot_20230223-082246_Gmail

  

  Business response

  02/24/2023

  Dear **************,
  
  We sincerely apologize that our service has not met your expectations. We want to assure you we are working to give you the best experience moving forward. We have had another leader on our team give you a call to discuss your concerns and walk you through next steps with your case and resolution to your concerns. Please answer their calls so that we can find resolve for you quickly.
  
  Thank you.

  Customer response

  02/27/2023

  (The consumer indicated he/she DID NOT accept the response from the business.)
  There has been no attempt to make good on the fault experienced by this company at all. No refund has been made to us and in actuality, funds were removed from the surgery plus card during my post-op appt. I am pursuing this further as my attorney said they are committing breach of contract and refuse to do anything. They have refunded us my x**

  Customer response

  03/02/2023

  I had to go to an emergency room 72 hours after surgery due to fever and complications, I was placed on two different antibiotics. Surgery Plus states will refuse to pay for the visit. When inquired what their emergency visit policy was, all they could tell me was that if I had called Surgery Plus they would have called the doctors office, which is a TWO HOUR DRIVE EACH WAY to make me an appointment to be seen. When I asked about emergency visits post surgery, they had nothing to say about covering a trip to the ** if an issue from a surgery one of their surgeons performed. When I asked the rep so if you are very ill due to the surgery you've had and need to be seen, unless you can get to the doctors office nothing is covered and just expect patients who cannot to suffer at home and possibly die from serious complications.... the surgery plus rep stayed quiet after I asked that detailed question
  
  I only had to go to the emergency room because it complications from the surgery their surgeon performed, which is a POST OP type of procedure, and Surgery Plus is supposed to handle your surgery and post op care where it is a stress free situation for the consumer and paid for since you have gone their their program under their providers.
  
  If you can not go to an emergency room to get emergency treatment and get it covered in the treatment that is supposedly offered, then you should be able to go to any doctor you choose and NOT FORCED to go through one that is located hours away.

• Initial Complaint

  02/10/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Answered

  More info

  They are forcing us to only go to a choice of one doctor because the other company that had the approval was in error. So we have to go through SurgeryPlus at this point even though they only offer one doctor. We have to wait weeks or months because we have to resubmit everything again. He is at high risk and living on pain meds. We are talking cervical spine surgery and has a history of blood clots. Otherwise, they want to send you out of town.

  

  Business response

  02/14/2023

  
  Mr. and ********************* contacted the SurgeryPlus center on February 8, 2023 to advise they were scheduled for surgery within 48 hours. The procedure was scheduled with a doctor of choice however not within our network of providers and not covered by their company insurance. A member services supervisor from EHD explained the cost impact of remaining aligned to their doctor and the benefits and cost savings of partnering with our program. We understand that this is a stressful time and experience for ******************** and his family and in an effort to expedite support, we have opened another case. We have shared this with him and we are closely monitoring decisions and progress.
  

*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. ↩