Western Health Advantage

Consumer States;Yes, I do believe the situation is rectifiedHowever, I do not take that as an excuseIt should not take phone calls to process a claimWHA has serious customer service issues

Thank you, again, for allowing Western Health Advantage the opportunity to respond As of June 13, 2017, Mr [redacted] account is in positive standing, and is up to date His claims for the service that he received on January 09, have both been entered into the Plan's claim system, and appropriately reflects $190.00, total, being applied towards his deductible As of June 13, 2017, Mr [redacted] online accumulator has also been updated and reflects accordingly to show that a total of $for his visit, on January 09, 2017, has been applied towards his deductible.Again, Mr [redacted] did not receive excellent customer service during this time, and Western Health Advantage acknowledges and apologizes for the customer service experience he received We will continue to work diligently with our Member Services Management Team to improve the quality of customer service and follcare, provided to our members

Thank you for offering Western Health Advantage the opportunity to address this issue with the Revdex.com. Due to confidentiality requirements of the Health Insurance Portability and Accountability Act, Western Health Advantage is not permitted to disclose information concerning an
individual’s health care coverage unless the member has provided a signed Authorization for Use or Disclosure of Protected Health Information, specifically authorizing the business to make a disclosure.Western Health Advantage is a Health Maintenance Organization (HMO). Under the Knox-Keen Act, for claims timeliness, AB1455, Section 3, Section of the Health and Safety Code, “a health care service Plan, including specialized health care service Plan, shall reimburse claims or any portion of any claim, whether in state or out of state, as soon as practical, but no later than working days after receipt of the claim by the health care service Plan, or if the health care Plan is a health maintenance organization, working days after receipt of the claim by the health care service Plan, unless the claim or portion thereof is contested by the Plan in which case the claimant shall be notified, in writing, that the claim is contested or denied, within working days after receipt of the claim by the health care service Plan, or if the health care service Plan is a health maintenance organization, working days after receipt of the claim by the health care service Plan. Although we understand how the member’s dissatisfaction came about, upon receipt of the claim, WHA processed within the working days The claim was received on 05/03/and processed and closed the claim on 05/24/2017. The claim information updates, thereafter, to reflect the appropriate up-to-date accumulator.Western Health Advantage takes customer satisfaction very seriously. We apologize if our member did not feel that he/she received satisfactory customer service during this time. We would welcome him to contact our Member Services Department for assistance, or he/she may wish to file a grievance with the business. We will carefully review his/her concerns and respond within the 30-day timeframe

Thank you, again, for allowing Western Health Advantage the opportunity to respond.  As of June 13, 2017, Mr. [redacted] account is in positive standing, and is up to date.  His claims for the service that he received on January 09, 2017 have both been entered into the Plan's claim system, and appropriately reflects $190.00, total, being applied towards his deductible.  As of June 13, 2017, Mr. [redacted] online accumulator has also been updated and reflects accordingly to show that a total of $190.00 for his visit, on January 09, 2017, has been applied towards his deductible.Again, Mr. [redacted] did not receive excellent customer service during this time, and Western Health Advantage acknowledges and apologizes for the customer service experience he received.  We will continue to work diligently with our Member Services Management Team to improve the quality of customer service and follow-up care, provided to our members.

Consumer States;Yes, I do believe the situation is rectified. However,  I do not take that as an excuse. It should not take 7 phone calls to process a claim. WHA has serious customer service issues.