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Simply Healthcare Plans

9250 W Flagler St STE 600, Miami, Florida, United States, 33174-3460

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I am the care giver for an 82 year old gentleman, who is wheelchair bound due to illness. The Simply Healthcare company is managing his medical services and, in Orlando, they use the We Take You Wheelcare Transport LLC company for transportation purposes when he needs to go to his therapists and doctor's office. Simply has used this company every time I have called for transportation needs, and every single time they are no less than 2 hours late in picking him up. The WTCYWT company has absolutely NO consideration for the needs of the passenger; once, he sat in the rain for 70 minutes until they arrived. I have complained to Simply, to no avail, so this makes me wonder about their relationship. This company operates from a residential area by people who barely speak English; thus, it makes me wonder if they are able to understand and take proper service requests. It is not clear to me if they have the proper business documentation, including insurance and drivers with the required licenses to operate the vehicles they drive. They are very unprofessional and, I believe, dangerous.

Desired Outcome

Other (requires explanation) Other (requires explanation) Please contact Simply Medical Care to learn more about the business they use and from the business to explain their awful practices and demonstrate they are licensed to operate their business.

Simply Healthcare Plans Response • Aug 28, 2019

We are unable to identify the Simply member referenced in this complaint in order to properly investigate. Please provide the members name, identification number, date of birth and address on file.

Customer Response • Sep 02, 2019

(The consumer indicated he/she DID NOT accept the response from the business.)
I left plenty of complaints with Simply Transportation about that vendor, plus the location should give them plenty of information to figured it out. It is just posturing on their part, but they may contact me directly at the phone number I provided.

Sincerely

Simply Healthcare Plans Response • Sep 16, 2019

We are in receipt of your file number XXXXXXXX. Please be advised that due to HIPAA Laws we are not at liberty to discuss this matter with your office. We will address the concerns directly with the complainant.

If you have any questions or need any additional information please do not hesitate to contact me directly at (XXX)XXX-XXXX.

Thank You,

***
Grievance Analyst II
Medicare Complaints, Appeals & Grievances

Simply Healthcare will not honor warranty of item purchased through their contracted 2018 Audiology provider after changing contractor in 2019.
I purchased a hearing aid at the 2018 Audiology provider, HearUSA, for Simply Healthcare. Hearing aid came with a 2 year replacement warranty. This transaction was in 3/2018 and my hearing benefits of $1500.00 were applied along with my out-of-pocket payment of $695.00.
I lost the hearing aid in 11/2018 and reported this to Simply who recommended that I wait until 2019 renewed hearing benefits which would pay for replacement. Jan. 2019 Simply contracted with a different Audiology provider, 20/20 Hearing & Speech. This new company told me they were not accepting Simply Healthcare. I then ordered the replacement hearing aid from HearUSA at an out-of-pocket cost of $450.00.

Desired Outcome

Simply Healthcare would not allow me to speak with an Administrative person and only expressed that my situation was "unfortunate" I had waited 3 months for a resolution and then ordered and paid for the initial hearing aid.

Simply Healthcare Plans Response • Mar 13, 2019

Please see response letter attached.

March 13, 2019

***
Revdex.com Services Specialist
XXX XXX-XXXX ext 124

REF: Complaint ID#: XXXXXXXX
Consumer: ***

The Medicare Complaints, Appeals & Grievances (MCAG) Department has reviewed the concerns in
regards to memberâ??s dissatisfaction with paying out of pocket to Hear USA $450.

Please be advised that the memberâ??s reimbursement request in the amount of $450 which was paid out
of pocket to HearUSA on February 1, 2019 to replace the hearing aid, was received by our Claims
department on February 28, 2019. The health plan has a processing timeframe of 60 calendar days. We
have been informed that this request has been processed and a response will be provided to member
under a separate cover via mail the Explanation of Benefits (EOB).

Furthermore, please be advised that we strive to provide the best possible service, and we are sorry that
the member was not satisfied with the services received and we regret any inconvenience or frustration.

Advised member to please keep in mind that if they encounter any issues in the future where one of our
participating providers is informing that they are not accepting the plan and/or have no availability, it is
important to contact our Member Services department in order to assist in locating another
participating provider in the area. Member was contacted on 03/07/2019 and provided the resolution
verbally and we also mailed the resolution letter to her on the same day.

Thank you,

***
Regulatory Compliance Consultant

Customer Response • Mar 19, 2019

Received phone call from Simply informing me that a check in the amount of $450 was being processed and sent to me for reimbursement. As of this date, 3/18/19, I have not received the reimbursement.

Simply Healthcare Plans Response • Mar 20, 2019

Good Morning, member was issued a check on 3/16/2019 in the full amount $450. She should be receiving it shortly.
Thank you,
***
Simply Healthcare Plans

Customer Response • Mar 25, 2019

(The consumer indicated he/she ACCEPTED the response from the business.)
I have been fully reimbursed and am satisfied. Thank you for all your help!

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Address: 9250 W Flagler St STE 600, Miami, Florida, United States, 33174-3460

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