Moda Health

I contacted the customer service many times regarding two claims that I had submittedI had been told to submit my Out-of-Network claims in order to be reimbursed the 50% of the 100% that we payUnder MyMODA, it states that my daughter's Out-of-Network mental health visits are payable at 50%After waiting, frequent calls to CS, and the claims finished processing, I was told that the entire amount that I have been paying went toward the Out-of-Network deductible, not 50% of itThey wouldn't reimburse any back to me until the deductible had been met firstThe CS representative said that there should be an asterisk on MyMODA to indicate that the deductible should be met first before reimbursingThere is no asteriskShe checked her MyMODA and stated that there was none on hers as well and stated that it was confusingMODA has left Washington, so we don't carry the health insurance anymoreI am not happy with the communication of the claimAt least with our new insurance departmen

Our family had insurance through MODA in December 15th, we had an insurance broker change coverage for myself and the children, but my husband remained with MODA January 12th, I noticed they charged us the full premium for January- after we also paid our new carrier our premium I immediately called MODA to cancel policy, and they said it would be taken care of within 5-business days We finally got reimbursed on the 20th Low and behold, on the 27th of January, we had a random amount of $taken out of our checking account I was told it would be taken care of promptly, and we didn't see the money back in our account until February 3rd My husband went into the MODA office at the beginning of February, and requested that our EFT be turned off, and paid his premium that day Then on February 9th, MODA takes out ANOTHER $out of our account- after being told the EFT was turned off That is unacceptable On different occasions, they held our money for a least a week, if not more! We have a mortgage to pay, bills, groceries,, etcand they think it's OK to continue to keep taking money out of our account, when the premiums were paid I'm sorry to say that my husband remains with MODA We will be sure to change carriers for him in 2017, and am thankful myself and my kids are no longer with them I literally spent hours being on hold (caller # in January), for something that shouldn't have happened! I was on the phone with them so often, my year old said, "Not MODA AGAIN!"

Complaint: ***I am rejecting this response because:These people have caused me a great deal of hardshipRevdex.com is free to close this file, as I will be seeking a remedy elsewhereSincerely,*** ***

Moda is a messI pay premium prices that keep going up for services that keep disappearingThey switched networks to Beacon which has limited providers, terrible communication, lost my only doctor in the switch and not enough time to find a new insurance plan before the open enrollment endedIn general it's hardwhen you have to pay for an individual plan but now it's really uselessShady

Moda Insurance will not pay for the services and installation of a dental crown to DrAlan S*** The claim supplied by DrAlan S*** was rejectedModa Health has a process that they must have refund from the previous dentist(Smiles Northwest) who installed an inferior crown Smiles Northwest has not supplied full payment in as many as months DrS*** has been waiting for payment for about months

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to meSincerely, *** ***

Dear Ms***:
This is in response to the Revdex.com (Revdex.com) complaint ID: *** received at Moda Health on September 3, regarding an overdraft of $from Mr*** bank account. Mr*** had two payments taken for the month of August
2015. Both payments were in the amount of $One payment was taken by Moda Health in error. The second payment of $was reimbursed to Mr*** in four business days. Mr*** would like to be refunded the $that he is owed and to have the issue stop persisting
On August 11, Mr*** contacted Moda Health Customer Service and was advised that on August 6, we took $as an electronic funds transfer (EFT). There was another $payment taken on August 10, 2015. He was advised how to contact Moda Health and submit bank information to get the $overdraft charge refunded
On August 12, Mr*** was contacted and advised that the refund of $was being processed and to allow business days to receive the refund
On August 17, Mr*** contacted Moda Health Customer Service asking about the refund of $and why it has not been processed. He was advised that we have not received a bank statement showing proof of overdraft and was advised to resend. Mr*** was advised this refund might take two weeks
On August 26, Mr*** contact Moda Health Customer Service and asked for a status on the refund of $32.00. An email was sent by a customer service representative to a supervisor regarding the status of the $refund. The matter was looked into by the supervisor and the billing and eligibility department
On September 3, billing and eligibility requested a copy of the overdraft statement so they can process the refund.
After receiving the Revdex.com Complaint on September 3, I contacted Moda Health’s billing and eligibility department
On September 9, I received an email that we had received the overdraft documents from Mr*** and the $charge will now be deposited into his account within one week
Regarding the reason the overdraft fee takes longer to reimburse than the additional payment that was taken is that Moda Health has record of the double payment in the payment history and can immediately reverse the charge. It is easy to identify that two payments were taken and refund one payment. The overdraft fee is taken by the bank so in order to reimburse the member we need overdraft documentation to refund the fee. Sometimes these documents can take time to receive and the reimbursement of an overdraft can take 1-weeks from the date we receive this documentation
Although Moda Health cannot guarantee there will be no payment issues in the future we strive to provide the best level of customer service possible to all of our members
If we can be of additional assistance, please contact our office at, locally *** or, nationally*** and Telecommunications Relay Service at ***
Sincerely,
Peter C
Appeal Coordinator II
Moda Health Quality Programs

Moda Health responded to the appeal on October 5, The letter was written to MsRandi Bowers *** as the appeal was about her care and services. We are not able to attach a copy of the appeal response to this concern as there is no authorization on file that we can release the appeal outcome to Mr***. If Ms*** *** did not receive the appeal response, she should call into the customer service department to request that another copy of the appeal response be sent to her. Thank you

Complaint: ***I am rejecting this response because: I physically have evidence in my hand which contradicts both Moda Health and Peak dental health claims (PDH)The document is dated September 26th weeks after moda and PDH claimed they informed me that my services would not be covered. Based on the documentation provided Peak dental health was under the impression that Moda Dental would cover 50% of services which is what I was told and agree to.Sincerely,*** ***

MODA Healthcare is our Obamacare providerWith tax credits our monthly out of pocket premium for was Around April, my wife, who receives disability, had a) pretty much run through her deductible and annual total out of pocket with doctors, procedures, and medication and b) started to monthly try to justify her being qualified to be covered by making calls to the Marketplace and MODAMODA soon thereafter stopped sending monthly bills but would send a letter with a "random" number that was dueShe, despite repeated efforts can make no progressWhatever is said the phone call usually ends up with my wife being responsible for calling the Marketplace to verify her eligibilityThis is something she has done repeatedlyMODA have made various claims of balances due; from over $dollars to $to a monthly increase to$None are in any indicative of what I owe or provide any reasoning what-so-everFurthermore, despite accepting a premium payment of over $in ea

I believe that I have experienced a deliberate, essentially fraudulent attempt to deprive me of insurance coverageThe short version is that my health and dental insurance was cancelled days after my automatic payment was declined, and the notice, telling me of the problem, was mailed to me on a Friday, only days before cancellationThe letters notifying me of the problem were dated April 12, postmarked days later on Friday, April 15th, asking me to mail a check, and stating that my policy would be canceled if the check was not received by April 20thThe letters were sent to my previous address and did not reach me until after the deadlineEven if they had been sent to the correct address, I was at work on Monday, April 18th, and would not have seen it until late that night at the earliest, if they had been sent to my correct addressWhat are the odds, under the best of circumstances, that I could have actually received the letters on the 18th, and mailed a check and had it

Complaint: ***
I am rejecting this response because: I have still not heard a formal response or resolution form moda in regards to my complaintCan you please provide me an updateI went and looked at the Revdex.com online portal and it states the complaint has been resolved, but I have not existed a response from moda other than to state that they received my appeal on 09/06/ Thank you, *** *** ***
Sincerely,
*** ***

Complaint: ***I am rejecting this response because: I don't believe the business is taking the situation seriously, especially in regards to the possibility that Moda employees could have orchestrated the incidentI am also concerned that the business has failed to address what it intends to do with my HIPAA-protected information it received- supposedly by accidentI requested for them to destroy it- they have not indicated what action, if any, will be takenThe failure to properly address all aspects of the complaint in not satisfactory.Sincerely,*** ***

during the month of July I received my bills from Moda, they ha () when I called I was told that means you have a crediti called another timeon July I went to get a perscription and was told I did;t have health insurance, so I called Moda, I was told that I needed to pay the difference between ($283) $that was my bill and balance owed, I still didn't understand so I told them I would send the whole paymenti sent $via bank account, at that time I was told I had insuranceon Aug first I received another letter stating that I had lost health insurance for non payment premium due'JUNE 1? I called I was told that they didn't post my June payment there fore I was canceled, then I was told by another employee I was canceled June for non payment in July, when I have made phone alls on July 24,and said I would make the payment for July

When I first was shopping around for ins at the end of the Moda salesperson I spoke with said there was a day grace period for customers who bought their policy off the exchange, and days for customers who bought their policy on the exchangeSince we did not buy our policy on the exchange I believed I had a day grace periodI went online last weekend to pay our bill and there was no "ebill" tab to pay itEvery time you call Moda the voicemail states there are hundreds of callers ahead of youOn Monday the 22nd I called to pay our billThe 20th fell on a weekendI paid our nearly $premium for me, my husband and our month old daughter, and then the very snarky customer service agent informed me that despite what I was told about the day grace period and that there was no ebill option for us on the website that my payment may not be accepted and that we might be dropped from our insurance planWe also recently moved and our old address still shows on Moda's

I have spent several hours on hold and then speaking to multiple representatives at Moda DentalMy last interaction was with Trisha a supervisor whom I spoke with on 6/5/I explained her that Moda has a glitch in their computer system that has resulted in their system believing that I owe $each month rather than the $that is due each monthThis resulted in my receiving letters from Moda that since I hadn't paid my premiums my insurance was cancelled When I talked to Trisha she assured me this was not the case and that my policy was activeShe told me that I was still going to owe $for July and when I tried to explain to her this was not true, she would not let me explain but insisted on sending me a report of my payments made since I received this report that has errors I have left messages for Trish and another supervisor at their office but neither is returning my calls.The problem I believe stems from my premiums going from $a month to $a month

July 19, 2017ATTN: *** *** RESOLUTION CONSULTANTRevdex.comSERVING ALASKA, OREGON AND WASHINGTONComplaint filed by: *** ***ID# ***Case ID: ***Dear Mr***:This complaint is regarding Ms*** and her family’s dental policy with *** *** ** *** forthe
plan yearMs*** provided an explanation of the difficulties she has been having with*** *** ** *** regarding her dental plan monthly premium payments and the additions ofher spouse to her policyMs*** is indicates that her spouse received dental work in early 2017that was not covered by the dental planMs*** is requesting that her family’s dental policy becancelled because she feels that *** *** cannot seem to figure out when her last premiumswere met.We thoroughly reviewed Ms***’s complaintOur records show that in December wereceived a call from Mr*** to make changes to the family plan which Ms*** is the subscriberonIn April 2017, per a call from Ms***, this issue was recognized and corrected to have Mr***on his own plan effective December 1, and Ms*** and her children on their own planeffective December 1, There are notes showing calls related to getting the premiumstraightened out as the policy was applying premiums for members until changes were made inApril The premiums were corrected for both policies and we received payment up until theMay premiumAs of July 11, we received a request from Ms*** to cancel both policieseffective June 1, This has been completedOnce we put Mr*** on his own policy we wereable to reprocess his claims on his planHis claims have processed and he should have receivedexplanation of benefits showing the corrected processing.If we can be of further assistance, please contact our office at 866-940-or TelecommunicationsRelay Service at 711.Sincerely,Steven H.Appeal CoordinatorModa Health Quality Programs **Attachment redacted by Revdex.com Staff Memeber**

I enrolled the premium of Moda plan through Oregon HealthCare Marketplace in April My coverage of Moda payment started in April In some reason, The Marketplace mistakenly charged me without a tax credit, so I filed the appeal to the Marketplace In meanwhile, I was forced to pay from Moda the incorrect amount of $1,for April coverage The invoice number is *** I made a payment of total $ 2,via phone on June 5, The total amount of $ 2,that I paid included June's coverage of $ I received a letter from Marketplace to inform me that my appeal accepted in August
Moda sent me the refund the amount of $1,which was $short than I paid in June I sent an email on November 15, 2018, to Jennifer P***, Web Administrator, ***@modahealth.com, to ask the explanation the reason why I did not receive the full amount of I paid-$1,
I attached two copies of the invoice with the email to show her what I meant

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

Moda Health reviewed this appeal in November 2015. Our position stands. Today, we received a request for an external review which we will be sending to the independent review organization