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Neighborhood Health Plan Reviews (4)

May 12, Revdex.com of Eastern MA, ME, RI & VT Donald Lynch Boulevard, Suite Marlborough, MA Dear Revdex.com: We are writing in response to Revdex.com Complaint # [redacted] submitted by a Neighborhood Health Plan (NHP) member regarding claims that were reversed in errorThe member’s desired outcome is for NHP to pay for the referenced claims in full including any associated cost-sharing NHP has reviewed the member’s claims for services rendered by his Primary Care Provider in July of We discovered that due to an internal system error the claim in question was unfortunately reversed resulting in the member receiving a billThis claim has since been reprocessed and covered in full for this memberThe member also mentioned that his spouse was having an issue with claims for a routine examination as well; we have since outreached this member’s spouse and obtained permission to reprocess and correct her claims as wellCoaching has been provided to the Customer Service staff involved on the importance of following up with members in a timely mannerThis member can also submit for reimbursement for the amount he paid out of pocket ($58.91) prior to the claims being reversedI have left voice messages with my contact information to educate the member on the reimbursement processNHP apologizes for any inconvenience this has caused our member NHP appreciates the opportunity to review the member’s concerns and to make the necessary adjustments Our goal is to provide the best customer service experience for our members Should you or the member have any questions specific to this matter, please call NHP Customer Service at [redacted] Sincerely, [redacted] Appeals and Grievance Support Coordinator Neighborhood Health Plan

We are writing in response to Revdex.com complaint #***, submitted by Neighborhood Health Plan (NHP) member regarding the complication faced due to the erroneous monthly "cancelling" of their policy and being unable to utilize pharmacy benefitsthe member placed multiple phone calls between NHP and
the *** *** *** trying to resolve the situation with no successThe desired outcome is having the billing issue fixed and to be able to use their pharmacy benefitsNHP outreached our manager of Account Implementation as well as the *** *** *** to further look onto the premium billing discrepancyThe ** acknowledges the member has in fact had a series of misleading invoices and bills sent to them; due to this error, the account has not been up to date which has led to restrictions being placed on their policyThe policy was not cancelled, but rather there was a delinquency restriction placedDuring the restriction, members can access medical services, but they are restricted from using the pharmacy benefit until the account is up to dateThe ** has since escalated the IT fix that is needed to adjust the account appropriatelyNHP had voided the delinquency restriction in our system and the member can once again resume utilizing their pharmacy benefitsOur Grievance Coordinator has outreached the member and advised them accordingly and provided her direct contact information should they encounter any complications in the futureThe Health Connector also spoke with the member and gave them a number to call back if, for any reason, the billing discrepancy remains unresolvedthey will also be following up with the member when all the necessary changes have been processedNHP apologizes for any inconvenience experiencedWe appreciate the opportunity to review all concernsshould you or the member have any questions specific to this matter, please call NHP Customer Service at ***

May 12, 2017     Revdex.com of Eastern MA, ME, RI & VT 290 Donald Lynch Boulevard, Suite 102 Marlborough, MA  01752   Dear Revdex.com:   We are writing in response to Revdex.com Complaint # [redacted] submitted by a Neighborhood Health Plan (NHP) member regarding claims...

that were reversed in error. The member’s desired outcome is for NHP to pay for the referenced claims in full including any associated cost-sharing.   NHP has reviewed the member’s claims for services rendered by his Primary Care Provider in July of 2016. We discovered that due to an internal system error the claim in question was unfortunately reversed resulting in the member receiving a bill. This claim has since been reprocessed and covered in full for this member. The member also mentioned that his spouse was having an issue with claims for a routine examination as well; we have since outreached this member’s spouse and obtained permission to reprocess and correct her claims as well. Coaching has been provided to the Customer Service staff involved on the importance of following up with members in a timely manner. This member can also submit for reimbursement for the amount he paid out of pocket ($58.91) prior to the claims being reversed. I have left voice messages with my contact information to educate the member on the reimbursement process. NHP apologizes for any inconvenience this has caused our member.   NHP appreciates the opportunity to review the member’s concerns and to make the necessary adjustments.  Our goal is to provide the best customer service experience for our members.  Should you or the member have any questions specific to this matter, please call NHP Customer Service at [redacted].       Sincerely, [redacted] Appeals and Grievance Support Coordinator Neighborhood Health Plan

Revdex.com:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #[redacted]. I understand that by choosing to accept the business response that my complaint will be closed as resolved. 
Regards,
[redacted]

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Address: 253 Summer St, Boston, Massachusetts, United States, 02210-1114

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