Sendero Health Plans

This is the WORST company to try to get a hold of, and they are a health insurance companyWhat is more important than your health? Nothing! You can NEVER reach them, IF you stay on hold for the hour you have to wait you ALWAYS reach the wrong department and they give you a different phone number to callI have DIFFERENT phone numbers for this company and I still can't reach themI have also paid my premiums but haven't received my health insurance card and my information isn't recognized in their system, yet the took my money and show that they took my moneyI need to go see a doctor but cannot get ANY information on my policy so I can go see a doctorI have been on hold (right this very moment) for over an hour and a half!

Complaint: [redacted] I am rejecting this response because I feel that more notice should have been given that the account was to be cancelled other than one letter sent to the wrong addressWhy could I still log on to Sendero to pay $six weeks later? No message came up that the account was closed, no phone call or email receivedNothingI feel that any other business tha accepts payments online would have had some type of indication that the account was overdue or even closedI did receive a refund for the $and am still waiting on the rest of the refund that will be sent in the form of a check Regards, [redacted]

January 8, 0pt;"> [redacted] Revdex.com Corporate Office La Posada Drive Austin, TX On December 31, 2015, Sendero Health Plans (Sendero) received complaint ID [redacted] which was filed with the Revdex.com on December 8, We appreciate the opportunity to respond and provide you the resolution to the complaint presentedThe complainant obtained active health coverage with Sendero on June 1, The complainant’s health coverage was canceled for non-payment on September 16, 2015; per CMS guidelines, the complainant’s health benefits termed on August 1, On September 17, the complainant submitted one monthly premium payment after his coverage canceled which initiated Sendero’s refund process Sendero’s refund process can take up to weeks after the request is received and validation is complete On October 14, 2015, the refund request was sent to Sendero’s finance department, and the complainant’s refund was mailed on December 2, Two days after this complaint was filed with the Revdex.com the refund was deposited/cashed on December 10, Sendero understands how important member experience and satisfaction is We apologize for the length of time it took to process this refund, and we will use this situation to assist us with improving the process going forward Again, thank you for the opportunity to respond to this complaint

April 14, Roman"> [redacted] Revdex.com Corporate Office La Posada Drive Austin, TX On April 6, 2016, Sendero Health Plans (Sendero) received complaint ID [redacted] which was filed with the Revdex.com on April 5, We appreciate the opportunity to respond and provide you the resolution to the complaint presented The complainant obtained active health coverage with Sendero on January 1, per the CMS enrollment file received on November 19, The complainant was mailed an initial invoice on December 1, for the total premium amount due of $The complainant paid $of the monthly premium due on January 26, The balance remaining was $ Subscribers receive their enrollment packet along with ID cards once the first full month’s premium is received On February 2, 2016, the complainant contacted Sendero’s customer service department and confirmed that the $payment was received On February 16, Sendero followed up with the complainant to notify her of the outstanding balance on her account The complainant stated that her effective date should have been March 1, and that her premium should be less due to her plan change via the MarketplaceThe complainant’s premium change was later received by CMS for $ The complainant was mailed an invoice for March with the appropriate amount dueThe complainant was canceled for non-payment on March 22, per CMS guidelines Sendero reminded staff to provide balance information upon contact with subscribers when they provide premiums received /posted or any other request that are made during the communication Sendero attempted to contact the complainant via three different phone attempts to address to this concernAt the time of this notification, the complainant has not followed up to the voicemails left requesting a return call Sendero understands how important member experience and satisfaction is We will use this situation to assist us with improving the process going forward Again, thank you for the opportunity to respond to this complaint

Thank you f or the opportunity to address the concerns mentioned within this complaintOn 2/1/2017, Sendero Health Plans’ (Sendero) Member Advocate spoke to Ms [redacted] who stated that she did receive her member ID card and Welcome PackageAfter reviewing Ms [redacted] ’s account her ID card and Welcome Package were mailed on 1/3/ During the conversation, Ms [redacted] was asked if she received any medical care, prescriptions, and if she was not able to provide insurance information during those encountersMs [redacted] stated that she did go to a doctor’s appointment, and she could not provide insurance information at the time of the visitOur Member Advocate offered to call the doctor’s office to confirm eligibility, but Ms [redacted] could not recall the doctor’s name that she had the appointment with Sendero understands the importance of member satisfactionWe will use this situation to assist us with improving our processes going forward Again, thank you for the opportunity to respond to this complaint

Complaint: [redacted] I am rejecting this response because: This is not at all what I was told on the phone by ideal care before going to the ERIn addition, their policy says doctors may balance bill, but it implies that they will cover all hospital bills, and this is what their representative saidIn addition, Texas law says that insurance companies must pay for out of network emergencies to that the enrollee with not have to pay more than if it was an in network provider Regards, [redacted] ***

Concern: The member/subscriber is seeking clarification for the Silver Complete 87% plan vision benefits offered by IdealCare Explanation: The PDF copy of the Summary of Benefits for the Silver Complete 87% AV plan states "Routine Eye Care (Adult) — limited to exam per year"This PDF copy is located on the Sendero websiteMembers of all ages are eligible for one eye exam per calendar year after copaymenticoinsurance, if applicableMembers under years of age are eligible for one pair of eyeglasses, or an initial supply of contact lenses, in lieu of glasses every calendar yearEyewear for members over the age of is not a covered benefit The Evidence of Coverage, Complete Essential E0C, excludes eyeglasses or contact lenses, provided that intraocular lenses shall be specific exceptions to this exclusion; or examinations for the prescription or fitting of eyeglasses or contact lenses, except as may be provided under the Benefits for Routine Exams and Immunizations section of the EOC The Schedule of Coverage explains that an annual vision exam is covered for children and adults, 100% of allowed amount after a $0-$copayment per visitThe Schedule of Coverage also explains that annual prescription eyewear is covered for children only and 0-50% of allowable amount after calendar year deductible Unfortunately, the vision 'drop down' option via the Sendero website states copay per eye exam visit and 10% coinsurance for glasses after deductible is met"The website did not state glasses are covered for children under the age of only Outcome of the Action Plan: Sendero Health Plans reviewed the sound wave from the member callThe member mentioned during the recorded call that a provider informed the member that he did not have vision coverageThe Sendero CSR immediately apologized for the miscommunication that occurred between the unknown provider and memberThe CSR informed the member that he is covered for one routine eye exam via the benefit plan he enrolled inThe member informed the CSR that the Sendero website states that members are covered for visions exams and glassesThe CSR explained that glasses are not a covered benefit for adults, and the member said 'thank you' for the information Sendero Health Plans initiated a plan of action to prevent this miscommunication from occurring again in the futureThe Sender() website has been edited to reflect that benefit for glasses is only for children under the age of Also, Sendero Health Plans will add the same clarification to all of the Summary of Benefits distributed and available to membersLastly, Sendero Health Plans reached out to the member to clarify the benefits, discuss how to make his premium payment, and the process to receive ID cards and welcome packet materialsThe member was not able to speak at the time the call was made, and the member instructed he will contact the plan when he was available

Complaint: [redacted] I am rejecting this response because I feel that more notice should have been given that the account was to be cancelled other than one letter sent to the wrong addressWhy could I still log on to Sendero to pay $six weeks later? No message came up that the account was closed, no phone call or email receivedNothingI feel that any other business tha accepts payments online would have had some type of indication that the account was overdue or even closed I did receive a refund for the $and am still waiting on the rest of the refund that will be sent in the form of a check Regards, [redacted]

Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [redacted] ***From: [redacted] [mailto: [redacted] ] Sent: Wednesday, January 11, 12:PM To: info Subject: Complaint # [redacted] Regarding my complaint lodged against Sendero Health, I would like to withdraw the complaint after I was contacted by them by different people who addressed and resolved my issues and had adequate explanations of why there were issues in the first placeI'm not sure if this is the proper way to proceed, but I didn't see a way to do so on the Revdex.com website.Thank you, [redacted] ***

This is a terrible company It takes forever for them to answer the phone, IF indeed they ever do They have no idea how to lookup standard medical coding So when you get scheduled for a mammogram screening, it is likely NOT going to be covered if the doctors office used the wrong code Sendero has no idea what the right code is and cannot provide any information on how to correctly get things coded for routine wellness exams This company is a sham Don't waste your money buying ANY coverage The doctor's facilities they cover are a nightmare and severely limited

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

February 9, [redacted] Revdex.com Corporate Office La Posada Drive Austin, TX On 2/1/2016, Sendero Health Plans (Sendero) received complaint ID [redacted] which was filed with the Revdex.com on 1/28/We appreciate the opportunity to respond and provide you the resolution to the complaint presentedThe complainant was enrolled with Sendero effective 5/1/ Sendero mailed the subscriber two invoices which totaled $to ensure continued coverage The complainant’s health coverage was later canceled for non-payment on 8/31/per CMS guidelines The subscriber does not have a balance with Sendero for the benefit yearOn In January 2016, CMS sent Sendero an enrollment segment for The subscriber was sent an invoice due to the active enrollment segment sent from CMS After the subscriber contacted CMS, CMS provided Sendero guidance to terminate the current coverage for the subscriber effective 2/12/Sendero staff contacted the subscriber on 2/4/at 4:PM regarding this concern On 2/9/at 12:PM Sendero staff spoke with the subscriber and confirmed no payment is due In addition, the subscriber was ensured that Sendero received the term segment from CMS for the benefit year and no payment is dueSendero understands how important member experience and satisfaction is We apologize for the inconvenience created due to the subscriber receiving an invoice, and we will use this situation to assist us with improving the process going forwardAgain, thank you for the opportunity to respond to this complaint and assist the subscriber

Complaint: [redacted] I am rejecting this response because: they did not clearly communicate any of this information to me, clearlyThe right hand does not know what the l ft hand is doing in their offices They falsified their recordsMy phone has not been disconnected, has never been disconnectedThey did not record all of the times I called and was given incorrect informationAlso, in regards to the coverage question, this was not the first time I had called to ask about my coverageI spoke with an individual in April who confirmed that a procedure would be coveredIt was notThis was for a colposcopy I had to have performedMy husband and I ultimately decided it would be easier to just not pay out insurance bill and get cancelled as opposed to dealing with Sendero any longerThis experience has been terribleI have never worked with such an awful insurance company before Regards, [redacted] ***

Thank you for the opportunity to address the concerns mentioned within this complaint Sendero Health Plans’ (Sendero) Member Advocate attempted to contact Mr [redacted] on 4/13/ Our Member Advocate left a voicemail requesting a return callOn 4/14/2017, the Member Advocate was able to reach Mr [redacted] who was concerned that his payments had not been posted to his accountPer Mr [redacted] , his bank mailed Sendero four checks: one on 12/16/for $378.99, 1/17/$378.99, 2/21/$and 3/21/$ After review, Sendero’s Finance Department concluded that the checks mailed on 12/16/for $and 1/17/for $were sent to our previous / old lockbox, but both payments have been posted to the Mr [redacted] ’s accountIn regards to the checks mailed on 2/21/for $and 3/21/for $468.81, those payments have not been received On 4/18/2017, the Member Advocate spoke to Mr [redacted] , and explained that the checks sent on 2/21/and 3/21/had not been receivedMr [redacted] was advised that he will need to reach out to his bank and request a stop payment on both checksAt this time, Mr [redacted] confirmed that both outstanding checks had not cleared his account Mr [redacted] expressed dissatisfaction in regards to the fact that Sendero had not received the outstanding paymentsThe Member Advocate explained that Sendero cannot credit the account, because his payments had not been received On 4/24/2017, Mr [redacted] contacted Sendero, and stated that his bank reissued a check for $on 4/20/As of today, Sendero has not received the payment, but as soon as the payment is received Sendero will notify Mr [redacted] Sendero understands how important member experience and satisfaction is We will use this situation to assist us with improving our processes going forward Again, thank you for the opportunity to respond to this complaint Sincerely, The Member Services Team

Their website shows wrong amount of premiumI have been calling for months to fix it, I wait on the line for minutes and then the system says "There is nobody to answer your phone, please leave a voicemail"I have not received my ID card and coverage because of their sloppy serviceI left voice mails, nobody returned my callsI am so hopelessI don't know what to do now

Thank you for the opportunity to address the concerns mentioned within this complaint Sendero Health Plans’ (Sendero) Member Advocate spoke to Ms [redacted] on January 11, After speaking to Ms***, she stated that she was concerned as she had not be able to reach our Customer Service Department last weekOn Tuesday, Ms [redacted] received a voicemail asking if she wanted a call back from our Customer Service Department’s automated system do the overwhelming number of calls being received Ms [redacted] responded that she did want a call back, and a Customer Service Representative called herShe stated that she did need additional assistance with obtaining an appointment with a primary care physician, and she was assisted and an appointment was scheduled Ms [redacted] confirmed that her premium is $not $Ms [redacted] was satisfied with the follow up she received, and did not need any additional assistanceMs [redacted] also stated that she would remove the complaint as she was satisfied with the outcome

Complaint: [redacted] I am rejecting this response because: the issue is still not resolvedThey claim to not be receiving the payments from the bank but based on the unprofessional nature of the handling of all payments so far it seems more likely they have received the payments but have lost themThe bank has not just re-issued the payment stated by Sendero in this response but both payments in question were resentStill waiting for them to credit my account fully so I don't know why they are even updating this complaint as it's not resolved Regards, [redacted]

Thank you for the opportunity to address the concerns mentioned within this complaintSendero Health Plans’ (Sendero) Member Advocate spoke to Mrs*** on January 6, We advised the member that we did not have any request on file for home health services by her referring provider We
informed Ms*** that her Case Manager (CM) had contacted the referring provider on December 29th, 2016, and advised the provider that a request for home health was needed in order to proceed with approvalAs of January 6, 2017, Sendero does not have a request from the provider for the service Ms*** was advised that she had not made her premium payment for JanuaryMs*** was assisted on how to make a payment so she could obtain her medication which was mentioned during the conversation Ms*** was referred to Case Management for additional assistance on obtaining the care she was seekingThe CM called Ms*** to provide assistance, but at that time she was not availableThe CM spoke to the home health agency, and they stated that they received the order for home health from Dr*** on January 3, 2017, but they had contacted the surgeon who submitted the orders in order to confirm the member’s location/residence and had not received a responseAfterwards, the home health agency submitted a request, and it was approved for Ms*** to receive the serviceSendero understands how important member experience and satisfaction isWe will use this situation to assist us with improving our processes going forward

September 16, *** ***, Dispute Resolution Specialist Revdex.com serving Central, Coastal, Southwest Texas and the Permian Basin Soledad StSteSan Antonio, Texas On September 14, 2016,
Sendero Health Plans (Sendero) received complaint ID *** which was filed with the Revdex.com on July 26, We appreciate the opportunity to respond and provide you the resolution to the complaint presentedSendero reviewed the complainant’s account which reflected on July 25, the member contacted Sendero, because she could not get her medications Customer Service advised the member that the reason she could not get her medication was because her premium had not been paid in full According to Sendero’s records, the member was enrolled in the automatic monthly back draft program, but her March-May transaction attempts returned non-sufficient (NSF)On June 20, the member was advised of the NSF barrier, and she made a payment on June 21, for March and April. On July 6, she paid her premium for May and June As of today, the member owes her premiums for both July and August. In regards billing codes, the member called on Friday, March 25, to ask if a particular code was covered (a benefit). The Customer Service Representative wanted to confirm the answer with her manager, who was not available, and asked if she could call her back after she received confirmation. The member agreed, and on Monday, March 28, the Customer Service Representative attempted to contact the member to advise her that the specific code was a covered, but the member’s phone was disconnected or out of serviceSince March 28, 2016, Sendero has made several attempts to contact the member on four different occasions, and she has not returned the phone calls or voicemail Sendero called the member on July 26, 2016, July 27, 2016, August 2, and August 8, 2016. Sendero understands how important member experience and satisfaction is. We will use this situation to assist us with improving our processes going forwardAgain, thank you for the opportunity to respond to this complaintSincerely, The Member Services Team

Sendero's Member Advocate spoke to Ms*** on 8/30/The member was not satisfied that her premium payment had changed from a zero dollars to $per month. The Member Advocate explained to Ms*** that we received confirmation from the Marketplace Exchange that her premium
payment should be $per month since January. The Member Advocate advised Ms*** that IdealCare sent a corrected invoice showing that she had a balance due for the previous months
To help bring clarification to the situation, Ms*** and the Member Advocate called the Marketplace Exchange together to verify why they had changed her premium payment from zero to $After speaking to the Marketplace Exchange they could not provide an explanation as to why there was a change in the monthly premium. The Member Advocate asked Ms*** if she was okay to request the Marketplace Exchange representative to provide a point of contact for their upper management to help provide more guidance or direction on why the change occurred, and if the premium could be changed back to zeroAfter speaking to upper management, Ms*** was awarded a zero dollar monthly premium paymentThe Member Advocate proceeded to update her account on 8/31/to reflect a zero balance. The Member Advocate spoke to Ms*** on 8/31/and advised her of the update and she was satisfied
On 9/5/2017, the Member Advocate spoke to Ms*** as a follow up to their previous communication. Ms*** was advised that on Friday (9/8/2017) IdealCare sent an updated file to the Marketplace Exchange advising them of the update to her advanced premium tax credit (APTC), and that the APTC would cover her premium payment in full. The Member Advocate confirmed that she was able, had access, and did not need assistance with finding a medial provider during this time period of updating her account. Per Ms***, she was fine and did not need to seek any medical care at this timeIdealCare received confirmation from the Marketplace Exchange on 9/11/that they received and updated Ms***'s account/profile appropriately