Ameriben

My claims for PT and OT visits in Sept, October and November 2022 have not been paid. Received a FINAL statement yesterday for the Sept Claims. Spoken with AmeriBen on a number of occasions. One rep indicated that my plan has '60 hard visits' Another rep informed me that after 17 visits I need Pre Auth or certification. The Rehab clinic called AmerIBen to verify Auth status as they were told at the beginning of my therapy I had 60 visits. And the did not need Auth. But they do need the clinical progress notes. Thru my HR Dept I was able to get a reference number to include on the reprocessed claims. I still have not received an updated EOB on the claims and the Hospital Rehab Dept has told me that they resubmitted the claims. As the claimant I cannot submit the Auth, the facility has to do that. I get a story of two when I call them. But the jest is they do not need Auth and I am being billed for a benefit I was told I had. It has been almost five months. I have not gone in for any further visits with PT and OT as I do not want to incur any expense until this matter is resolved. So my therapy is pending. As a stroke patient (I have had 3 strokes a year and a half ago) I am frustrated that my recovery is being delayed. Seems like a simple solution. Call for the pre Auth submit the clinical progress notes with the reference number I provided. Dare I call AmeriBen once more to see how many visits I am entitled to. It is curious I have never heard the term '60 hard visits' that was the AmeriBen Rep that used that phrase.

I was informed by Ameriben staff I do not have any more bills to pay however I received a bill back on 9/27/22 for $217.20 spoke to them on 9/28/22 they informed my I do not have to pay anything as I already made my copay of $150 and that I met mt deductable. they were going to resubmit that... Low and behold another bill came in for $217.20

Ameriben has sent me one EOB that shows the provider would be paid for an injection I had received that was preapproved by them. The provider bills Anthem. Anthem sends the provider a different EOB that does not show the payment and says I am responsible. I call Amerien at least 4 times in the last 3 months. They said this is a problem they are aware of with Anthem and are trying to resolve it. They tell me there is not a phone number to contact Anthem and only emails are sent to them which have not resolved the issue. I was told it would take up to 30 business days to resolve. We are now going on 50 days with no resolution. I am very frustrated and do not like working with a third party administrator, especially one who says they have no way to contact the insurance company they are working with!

I met my deductible out of pocket over a month ago. Still having to pay rx deductibles. I called and was told it would be fixed. 2weeks later I tried to get another rx and same issue. I called back and oh I’m sorry it never got fixed. Now after 3-4 phone calls to medical side and 3-4 more to rx side it’ll be 2 more weeks. In the mean time I’m still paying for rx which will b over 3-400 and I’m sure it’ll b real fun trying to get reimbursed. Also I have to be the mediator. I have to keep calling back n forth to give each other messages. Absolutely pathetic!

For 8 weeks now we have been trying to resolve a prescription problem. We have met our deductible (medical + prescription costs) for 2021 and should now pay 20% of prescriptions. We have EOBs that show we hit deductible in June (today is 10/10/21). Ameriben representatives have verbally CONFIRMED and have agreed that this is correct during MULTIPLE hours long phone calls. However, the amount ameriben has consistently sent to optum (prescription provider) does not match eob statements. Optum representatives have communicated on our behalf to ameriben that deductible amounts reported to them are wrong.

Looks like nothing has changed. Refusal to pay for procedures previously covered. Denial of procedures needed for diagnostics resulting. Went appears are made, told they procedure is approved, and then formally denying at a later date. Caught them in lies to my provider and myself for the third time. Absolutely the worst I have every dealt with.

After receiving an injury to the mouth during a university sponsored practice resulting in a broken front tooth on December 6th, 2017, I was sent to ***. There the tooth was temporarily fixed. Upon a consult with Dr. *** at *** it was suggested that an implant for the tooth would be needed. This fix was followed through with in April of 2018. Further work was done for the implant and concluded in April of 2019.
During this time I was assured by my university that following payments by my primary insurance up to a deductible of $1000, Ameriben would pick up the rest of any payments as the secondary insurance company. However, although my primary insurance has surpassed this deductible, Ameriben has denied paying the rest of the bills. We have complied with all of their requests including sending all EOBs and working with all parties involved to get all necessary information. In speaking with multiple staff at Ameriben who have since followed up with upper management, they have concluded this process has been messed up by one of their employees. Despite acknowledging this, the bills remain unpaid by Ameriben and the dental offices are threatening to turn me, a college student, into collections for a bill that should be paid by my university's insurance.

The status of my health plan and claims paid since January 2018 is not correct and is incorrectly as processed by Ameriben for my employer.

This is causing major financial issues with my required healthcare as they do not show my deductible and out of pocket as met; thus I am continually being charged even though I have overpaid on the deductible and out of pocket maxes. Per my plan selection: Anthem HSA INDIVIDUAL ONLY (see attached confirmation of benefits).

My correct benefits are as follows: (In Network) Deductible: Employee : $2,000 (In Network) Out of Pocket Max: $2,500 The deductible and out of pocket max in the system(s) do not reflect any monies I have paid out since January 2018 per the claims in the system(s). I have opened cases and requested escalations with Ameriben since June 2018 and still do not have a resolution or correction.

Your help in resolving this issue as soon as possible is greatly appreciated.

I try to utilize my benefits. The provider is told I'm not active so I pay out of pocket. However, I pay my premium through my paycheck as it is my employer provided insurance.
I tried to file a claim this time for my dental bill. It has been 2 months with a still in review answer. Sometimes I'm told they have no documentation. Other services services members tell me its pending. Why pay for insurance that never can be used??? I pay them. Then full price to a supposedly approved provider. Its bordering on fraud.

I originally did this on the *** site, but I realize that AmeriBen is the 3rd party people who actually keep giving me the run around. I am praying between the two complaints that they actually get something done. November of 2016 my son broke his tibia during a football game. He had to have surgery. The doctor's got everything pre-certified and ready. I thought everything went smoothly. My ex husband sent me a letter that needed to be filled out because of the nature of the injury. I filled it out, sent it back and thought nothing else about it. I assumed the way the secondary insurance worked I wouldn't have to do anything after BCBS did their part. It wasn't until the end of July/beginning of August my son said that some collection agency was calling said I owed some medical bills. I called and was told I owed *** Hospital 35,000. Needless to say I made a call. Because my son was over 18 I was told they could speak to me only if he gave permission, which he did. I was then told that they had not received the form. I told them that I sent that to them back in January. They said they didn't receive it. After several calls and I am pretty sure waiting for them to get it in the mail, I faxed the requested information 9/13, they said that wasn't good enough and mailed papers for me to have him sign including authorization for me to talk to them because they made him verbally authorize it every time I called. By the time I got the paper in the mail it was 9/24. I faxed it to them 10/3. They said they never received it so I sent it certified. After the post office stated it had been delivered I called and they still said they hadn't received it. At this point I asked for an email address. I emailed pictures of the information only to be told my son didn't sign a piece of paper (of which I was authorized to do for him). Once I saw him to sign it and email it, it was then it's going to be 2 to weeks. Well 4 weeks later nothing has changed