Essence Healthcare Reviews (%countItem)
I have a Medicare Advantage program through Essence and am entitled to 10 round trips per year or gasoline reimbursement. On 2/11/20 I took a trip through MTM to and from physical therapy as I was being treated for acute sciatica. My pick-up time after physical therapy was at 3:45 p.m. but the driver failed to show until 4:45 p.m. After returning home I called Essence to file a complaint, but had to go through 3 different people to do so. Essence mailed me a letter dated 3/5/20 stating that I signed a trip sheet showing the time of pickup was 3:45 p.m. But the driver lied: I downloaded my Verizon phone records for that date, and they show that I called the subcontractor, Altair, at 3:47 and 4:08 p.m., and that *** dispatcher called me at 4:43 p.m.
As a valued added benefit to
our members, Essence contracts with a transportation vendor to facilitate rides
to and from medical appointments for members who may not have ready access to
adequate transportation. After being alerted to this particular
issue by the member, we immediately began an investigation. Based on that
investigation, we found that the member was clear with the transportation
vendor on their requested pick-up time and the driver assigned failed to meet
their obligation as well as failed to acknowledge their error to the member or
us. Given our findings, we are currently in the process of
addressing this issue directly with our transportation provider and will be
taking corrective action accordingly. We thank the member for raising the
issue, apologize for the substandard experience they had, and will be working
diligently to ensure a consistent and reliable transportation experience for
our members going forward.
I am rejecting this response because: I want to know what disciplinary action, if any, is being taken against the driver, what steps are being taken to prevent falsification of trip logs and to allow the vendor to know the exact time of pick-up/drop-off, and what steps are being taken to inform Essence members on how they can appeal grievances internally if they disagree with the original decision. This latter is a systemic issue that can be easily addressed.
I was a driver for a medical transportation service for 7 months and the company (US DOT certified) could at anytime track my location.
Last year before Christmas I had tried contacting Essence to get my Insurance Card. They told me to wait at that time. I called on January 6th and spoke with *** and she said the card had been sent to the wrong address and that she would make sure a new one gets sent out. It has been over a week and still nothing. I need to make appointments with my doctors. I can't go into the office without one as I will get penalized if I don't have insurance.
(January 20th at 12:40pm) Essence called me to let me know that they would have to check their records to figure out what was going on. They told me they would be in touch and apologized for my issues. (January 23rd) I spoke with ***. She wanted to know if I got my ID card and I told her no. She seemed surprised and asked about getting me it through email, which I don't check. She agreed to send it via postal mail but didn't give a timeframe. Beyond this, speaking with others around the retirement community I have found out that they are also having similar issues.
This company is milking Medicare. I called to get a referral to my neurologist who I have been seeing for 30 years. The primary care doctor denied the referral. My neurologist couldn't believe it. I called the company, Essence, and they gave me the referral, not the doctor. I think they were afraid of a lawsuit.
At Essence Healthcare, our main goal is to allow for the best care for our members. We understand your frustration with your experience, but in the end, we are glad the process allowed you to get the referral and the care you need from your neurologist. In the future, please don’t hesitate to call customer service with any questions or needs.
An office visit copay of $40 was charged to my insurance company but this was an overcharge. I did not have an appointment. I informed my insurance company that this was an error. The over charge was $40 and the insurance company finally resolved the issue in late October but at my expense. Initially they stated I had reached my out of pocket expense due to a surgery I'd had and the follow up rehab. They had instead took $40 away from my previously paid off out of pocket leaving me with a balance yet to pay of $40. I am not responsible for the $40 difference as I'd already met my out of pocket with my primary and secondary insurance.
Essence Healthcare received a Revdex.com (Revdex.com) complaint on 6/25/19 filed by member, ***. The Plan’s Compliance Department contacted the member on 6/28/19 to discuss his complaint and the member stated he believed a claim of his for date of service (DOS) 2/12/18 was handled incorrectly. The member’s claim from 2/12/18 was originally processed to show a member copayment of $40, but this claim was later adjusted in September 2018 to remove the copayment. Since the member met his Plan benefit Maximum out of Pocket of $2,500 in March 2018, the $40 copayment from 2/12/18 needed to be applied to the next claim paid by the Plan after the adjustment took place, which was a claim for DOS 9/7/18. The member believed the $40 copayment should have been applied to the next claim received by the Plan after 2/12/18 and not the next claim paid by the Plan after the adjustment. The Compliance Department spoke with the Plan’s Claims Configuration Team who advised that the claims adjustment was processed correctly and the $40 was properly applied to the next claim paid by the Plan after the adjustment took place.
The adjustment of the claim was impacting the member’s cost-share with his secondary insurance, Medicaid, for services received in May 2018. The member was advised the Plan would review his concern and it was confirmed that the claims adjustment process was handled appropriately. The member’s updated Explanation of Benefits (EOB) for the 2/12/18 claim was sent to his provider and all further coordination regarding his Medicaid coverage/cost-share needs to be addressed between his providers and Medicaid.
Almost two months ago I contacted *** a company I have used for over 20 years, for my supplies, to see about getting my cpap breathing machine for my sleep apnena fixed. They stated that they can no longer repair my type of machine and told be I am elgible for a new machine. I contacted my *** and she immediately wrote a script for my machine. I checked with *** and they received the script from the *** They stated the insurance have not improve it yet. After calling repeatedly between my *** and Essence Health. for over a month I heard nothing. The cpap machine is vital to my health. I have used it every night for over 20 years. I even bought on my own a backup battery pack just in case the power goes off. My health is at a critical stage. Im obese, have sleep apnea, diabetes, high blood pressure and heart problems. I filed a complaint with the compliance coordinator by sending two emails and did not received a response. I sent a letter to the appeals department and did not receive a response as well. Last week someone called about giving me a home test to see if I have sleep apnea. I didnt meet the requirements because of my health risk. Now they want me to do a sleep study at the sleep lab. This is just ridiculous considering my health. When I did it twenty years ago the test only lasted 40 minutes before they established I needed to be on the cpap machine. This test is a waste of time for me and will put more strain on my body. Essence health is doing everything it can to make it impossible for me to get a cpap machine that will give me a better quality of life and is putting my health in serious jeopardy, Finally they ignored my writing complaint and appeal. Overall is very poor and slow communication.
Essence Healthcare received notification of *** complaint on 2/18/2019. After receiving the complaint, the Plan reviewed the Beneficiary’s authorization and claim history and determined he has not purchased a CPAP machine while a member of Essence Healthcare. The Plan reviewed the Beneficiary’s call history and determined he has not contacted Customer Service to inquire about coverage for a CPAP machine.
The Plan contacted the Beneficiary on 2/20/2019 to inquire if he has a CPAP machine that he is currently using, and he confirmed that he has been borrowing a family member’s machine for two months. The Plan contacted ***, the durable medical equipment provider the member has been working with, on 2/21/2019 to determine the status of the member’s request for a CPAP. *** at *** confirmed that an order was received from the Beneficiary’s PCP but there was no supporting clinical documentation to support the medical necessity of the machine.
The Plan then contacted the Beneficiary’s primary care physician (PCP), *** office on 2/21/2019 to facilitate the authorization process for ***. The Plan spoke with *** at the provider’s office who confirmed the Beneficiary’s chart does not indicate he currently uses a CPAP machine and does not specify that a CPAP machine is medically necessary for his health.
The Plan contacted the Beneficiary on 2/22/2019 to explain that Medicare guidelines require an authorization for this type of equipment to support the medical necessity before coverage is provided. The Beneficiary was advised that he needs to schedule an appointment with his PCP for a full evaluation so clinical information can be provided with the order, or he will need to complete a sleep study. The Beneficiary indicated that he understood this information and would contact his PCP.
I am rejecting this response because:
I first want to thank the Revdex.com. It is because of this complaint it is the only reason why Essence Health is responding. I first want to clear a few things from the response from Essence Health. I sent them two emails about my grievance and mailed an appeal letter to the address that was given to me by the customer service rep. It is a false statement that I didn't call about my cpap replacement. Essence Health did not respond back to both of my complaints. I followed their policy that as stated in their members book. I am using an replacement cpap from a family member. The machine is old and out dated and does not work properly. That information is not relevant to this complaint. I have use a cpap machine for over 20 years since I was diagnosed with sleep apnea. I have been hospitalized several times under this insurance. While in the hospital each time the respiratory therapist makes it a priority to make sure I have a cpap machine if I was unable to bring one with me. It is in my medical file about my sleep apnea.
In the past if my cpap machine went out I would call the supplier and they would give me a replacement machine until they figure out if they could replace it or repair it. Usually the next day a new machine would be bought out to me. When It went out this time Essennce Health did not offer to give me an loaner machine. My *** was sent in a scrip immediately and the supplier basically gave my *** a list of things that kept I had to do for approval for a replacement machine. The list kept changeing it i
Essence receives money from the Federal Government to provide coverage in lieu of Medicare. They are STEALING from the US Government by taking premiums and not providing any service for said money. I was hounded by Essence Healthcare representatives until I finally switched from Medicare to Essence. I was assured that St Francois county MO was in their coverage area...they LIED!!! I reside in St Francois county, now Essence tells me they no longer service St Francois county so they are cancelling my coverage!!! NOW WHAT??? I need my health insurance. Essence has also been charging me an extra $27 per month claiming I had no prescription coverage for 77 months!!! This too is a LIE!! I provided proof that it was only 7 months, they REFUSED to correct the error and said I must pay that $27/mo penalty for the rest of my LIFE, based on their error!!! The only reason I didn't have coverage for 7 months is because Essence rep LIED when she told me I could switch from Medicare to Essence "anytime, open season doesn't apply. " Then I tried to sign up last April, they said I had to wait for open season for coverage beginning 1 Jan 2018. None of the people I've spoken to on the phone will help. I've spoken to those claiming to be a Supervisor, but they also refused to help. I am disabled and I have serious medical conditions, so I need to have medical coverage. PLEASE FORCE ESSENCE TO HONOR THEIR PROMISES AND PROVIDE THE SERVICES FOR WHICH THE US GOVERNMENT IS PAYING. Otherwise, Essence needs to be investigated and their government contract terminated. Thank you
On 4/9/2018, Essence Healthcare (“Essence”) was notified by the Revdex.com of a complaint filed by ***. *** alleged that the Plan lied to him about St. Francois County being located in the Plan’s service area. *** also stated that the Plan is charging him an extra $27 per month for his lack of credible drug coverage for 77 months, for which he stated he should not be responsible
*** is moving from St. Louis City to St. Francois County and when he called Essence’s Customer Service Department to notify the Plan of his address change, he was advised that St. Francois County is outside of the Plan’s service area.
Essence called *** who indicated that he was told St. Francois County was in the Plan’s service area when he met with a Sales Agent at *** in June 2016. Essence advised *** that St. Francois County was in the service area at that time, and that St. Francois was removed from the service area on 12/31/2017. *** was advised that he did not receive written notification that St. Francois was no longer in the Plan’s service area because these notifications were only sent to St. Francois County residents, and at the time the letters were sent, his permanent address was in St. Louis City.
Essence spoke to *** about his $27 monthly late enrollment penalty (LEP) for lack of credible drug coverage and explained that this penalty is assessed by Medicare, not Essence. *** was reminded that Essence sent him a letter on 1/16/2018 informing him of his LEP and providing instructions on how to submit an appeal/credible coverage information, but Essence never received a response, which is why he is being charged the $27 LEP.
*** understands that St. Francois County is outside of the Plan’s service area and that he will be disenrolled the first of the following month after his disenrollment is processed.
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Address: 13900 Riverport Dr, Maryland Hts, Missouri, United States, 63043-4831
+1 (314) 770-6096
+1 (314) 209-3234
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