Via Benefits

Per our records Mr*** was enrolled in a plan through Via Benefits Insurance Services from July - December 31, 2015. The requirements in place to qualify and the timeframe that qualified funds will be provided are set by the participant's former employerVia Benefits Insurance Services will continue to reach out to the participant directly to assist with resolution. We last reached out to Mr*** on 3/9/

Very disappointed that I was not told any changes to my insurance had to go through via and ended up losing my funding and said nothing I could do would let me be untitled to be reinrolled to get my funding benefit would gladly change back to original insurance but once they get you out it's their chance to pay you your benefit and less for them to pay

We are looking into this and will contact the participant directly
to address their concerns.

Towers
Watson's One Exchange is private Medicare exchange that is contracted by a
number of employers, including IBM, to work with its retirees and their spouses
and dependents in transitioning from group health care coverage to individual
Medicare health plans. Many of these employers...

have also set up a Health
Reimbursement Account (HRA) for their retirees who are losing group coverage to
help offset the cost of the individual Medicare plan.
We were
aware that Mrs. [redacted] had questions concerning reimbursement of her
prescription claim. We have tried several times to reach her. Our
Representative, Rhonda [redacted], which is mentioned in the complaint, was
finally able to reach Mrs. [redacted] on June 10, 2015. She confirmed that Mrs.
[redacted]'s reimbursement is scheduled to be sent on June 11, 2015. Mrs.
[redacted] was on this call and is aware of this. We are sorry for any inconvenience
Mrs. [redacted] experienced.
We trust
this is acceptable. Please feel free to contact us should you need any further
information.
Thank you.

Complaint: [redacted]
I am rejecting this response because:The business does not get the point. The point is that I want them to deal with my daughter in resolving my health reimbursement claim, as I do not understand an unresolved claim reimbursement from 2014 and their funding department was unclear, too.  Their funding department would talk to my daughter, but their customer service department would not. Having a survey analyst contact me early one morning and leave a message and not give me his direct line to return a call is not what I consider a resolution to my problems with OneExchange.  Their response is a non-answer. Are they going to deal with my daughter or are they not? If they don't require an authorization form on file to talk with her, why were we told to do this in prior conversations and why is their own form (NOT a POA form, but their own authorization form for release of personal information) available on their website and why did we complete one and have it faxed into their system?  I think the business was more concerned with a negative survey and this complaint, than actually helping me resolve my claim, with my daughter's assistance. 
Sincerely,
[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.
Sincerely,
[redacted]

OneExchange is contracted with EmblemHealth. At this time, there is nothing more we can do for this person. They are welcome to contact us again during open enrollment to look at other plans options.

A portion of this customer’s complaint seems directed at BCBS and their inability to provide the material that the customer asked to receive. As an insurance exchange we can assist the customer in requesting information from an insurance carrier, but unfortunately we do not have the ability to...

ensure that the carrier complies with the customer’s wishes. The customer complained that our associate promised to call him at 9am on 1/15/16. Our records indicate that our associate did call the customer on 1/19/16 at 11:47 am. On this call, our associate explained to the customer the information that was needed to file a claim and how to file a claim for reimbursement from his HRA account. Also, on the same call, our associate spoke to the customer’s wife to answer her questions about her plan and made a 3-way call with the insurance carrier to make sure that her needs were addressed with the carrier. At this point we believe we have done everything we can do to address the customer’s concerns and we are very sorry for any inconvenience that we may have caused.

After reviewing Mr. [redacted]'s account, we have verified that her funding has been reinstated back to October 2015. This is resolved.

Complaint: [redacted]
I am rejecting this response because: One Exchange absolutely did NOT tell me that Emblem Health was underwritten by HIP when my wife and I purchased the plan. It was stated it was a Emblem Health VIP plan.  When I spoke to the One Exchsnge earlier today, the representative (Nate) told me 'he never heard of HIP and that he had to google it to find out what it was'.  The representatives are in Salt Lake City and they most likely do not have HIP there. The main issue is HIP is not accepted by most doctors here on Long Islsnd.  I have avoided taking a HIP plan for years because I know it is difficult finding doctors who accept the plan.  It came to light after my doctor asked me to see a specialist. Whin I called to make an appointment, I was told the doctor did not accept HIP. I then called 2 more doctors before I found one to accept HIP.  My complaint is One Exchange did not tell me the I was buying a HIP plan.  They withheld the name of the company that I was purchasing. We thought Emblem Health was the plan itself.  Thank you for your assistance.
Sincerely,
Patrick Murray

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted]....

 The original problem appears to have been resolved, however a new issue has taken it's place.  I received a letter that showed the missing payments received, however, there were twelve (12) additional entries for payments processing.  I may NO ADDITIONAL requests for reimbursement.  I spoke with a supervisor at Towers Watson One Exchange & it appears that someone else's payment requests were processed on MY ACCOUNT!  I was even asked about my wife's premiums (I'm single).  There is now an overpayment which needs to be corrected for my account to balance.  I'm very concerned about someone else's reimbursements being processed into my account.   
Sincerely,
[redacted]

We apologize for the delay.  The issue with reimbursement for 10/1/2015 – 12/31/2015 premium expenses has been resolved.  Reimbursement should be received within 10-15 business days.  We consider this matter resolved.

Case #: [redacted]Per our records, before this complaint was filed on 6/10, the participants were mailed a check for May’s reimbursement on 6/3/2016 and they mailed a check June’s reimbursement on 6/20/2016.  We allow carriers 4-6 weeks from the time the premium is paid to send payment files...

for reimbursement.  Once these files are received it takes 11-14 business days to process a reimbursement. Because the participants receive reimbursements via a paper check, there is an additional timeframe for mail to be received.

Complaint: [redacted]
I am rejecting this response because: What OneExchange is doing is putting the "onus" on myself to on a now yearly basis to receive reimbursement from my second company's HPA.  I don't know how many other individuals are affected because they hadmore than one company providing a HPA for them.  My dealings with Tower Watsons OneExchange has been very negative, for instead of "fixing" the software that operates to reimburse individuals they have chosen to "stonewall" and repeat their same messageover and over.  They certainly are capable of fixing the Payflex software, for as more and more people retire and have more than one HPA, they will either force hardship thru missed reimbursements or the backlash will affect their business! 
Sincerely,
Alfred D[redacted]

Complaint: [redacted]
I am rejecting this response because: The answer was a boilerplate response from OneExchange.  It...

does not reflect all the hoops they had me jump through in order to receive my HRA funds.  This company delayed, delayed, delayed approving/paying my HRA funds for two months.  I believe there is a systemic problem that exists in OneExchange  as I have seen many other people with similar issues.  I made countless calls to their 'experts' non of which could help they just read from a script.  Not one would take responsibility to help solve the problem.  The reason for my request not being approved varied depending on who I spoke to.  The Funding department would never let me speak with anyone who could tell me specifically what was needed.  Ultimately I think I wore them down after a couple dozen calls, emails, Faxes, complaints to Revdex.com, emailing Towers Watson CEO and the North Carolina Insurance Commissioner, they approved my HRA request but should it be so difficult.This is not a company that is built to provide a service to its customers.  They were more of an impediment in my case, a senior trying to deal with a large company who continually threw up roadblocks in order to not pay me, the HRA funds that were set aside by my former employer for me. 
Sincerely,
[redacted]

We are looking into this issue and will contact the
participant directly to work towards a resolution.

OneExchange is unable to submit a request for an “Agent of
Record” change to an insurance provider. 
This request must come directly from the participant. The participant
must be enrolled into a plan through OneExchange to qualify for funding.  When the enrollment for 2016 was...

completed
outside of OneExchange, it caused a loss of 2016 funding.  To be able to qualify for 2017 funding, the participant
has the option to enroll in a plan through OneExchange during open enrollment
period (Oct. 15 – Dec. 7).

We will contact Mr. [redacted] directly regarding his concerns.

We apologize for any inconvenience.  The issue has been identified and resolved; all approved claims through current month and year have been processed.

Complaint: [redacted]
I am rejecting this response because: First point is there is no 90 day pay term, e.g. Retiree incurs major expense December 2014. Provider bills Insurance Jan. or Feb.Insurance pays only small portion. Provider bills patient in March or April. Patient disputes bill. Parties try to resolve May-June to no avail. Hearing set for September and not resolved 9 months later, thus no 90 day rule in effect. Secondly Onexchange  has mishandle paper work and even lost the refiling in February and never contacted beneficiary. Of course they are claiming they try very hard. One thing I have learned since we employed these folks is that they are very difficult to work with and this is not what the [redacted] Retirees intended. The purposeof Oneexchange is to process paper and reimburse retiree ASAP and always fault on the side of the retiree if there is any questions! I have been contacted by my former employer and The Board and a Representative of Oneexchange that confirms they messed this one up royally and agreed to get paymentto me as soon as the paper work is processed. So right now they have me in limbo waiting for their call. 
Sincerely,
Gary J[redacted]