WINhealth

Complaint: [redacted] I am rejecting this response because:This is a ridiculous loop holeA loop hole created by this insurance company to get out of paying for services neededThe company provided me insurance in [redacted] They also told me "out of state" procedures were not covered by the insuranceAfter the appeal they told me most people went to [redacted] clinic for the this type of treatment [redacted] is in [redacted] , so would they have paid for the hospital in [redacted] ? What about the surgeon? Also how was I supposed to find transportation hours away? And travel for hours after surgery? I will file another complaint against the Hospital in [redacted] , who told me this was an in network hospitalMy life was in danger, and I needed this surgery to continue livingSo the next time I am in danger of death, and I call the insurance company and they tell me the Hospital is in network, and they tell me it isI must still contact doctors I did not know I needed if they are in network? I will do the insurance company a favor and file a complaint against the doctor as well, stating he is difficult to contract withI will also file another complaint against the Hospital and surgeon, who told me there would be no trouble with win healthi do not consider this resolved at allPeople need to realize win health plays games with peoples lives for profit, and is not concerned about there customers well being at all Regards, [redacted]

Tell us why hereIn order to ensure that Ms [redacted] ’s complaints are completely resolved, we need additional informationWhile WINhealth did reprocess and pay some of Ms [redacted] ’s claims within the past couple weeks, we have no way of knowing if this resolves her complaints without claims numbersWe need to know what claims for both her and her son are being referenced and who the collection calls are from The Revdex.com must also understand and note that there is extremely sensitive health information at handAny personal or health information should not be made public Thank you, WINhealth

Win Health has made it extremely frustrating to resolve payment issues for a family member, who has recently been in the hospital, & had numerous tests doneThe hospital has said no payments were ever received from Win Health, Win Health has said they sent a check, but will not give information to the hospitalThis family member has been very ill, & spends so much time on the phone, & it's been going on for over monthsShe is now being sent to the collections

Tell us why hereIn order to ensure that Ms [redacted] ’s complaints are completely resolved, we need additional informationWhile WINhealth did reprocess and pay some of Ms [redacted] ’s claims within the past couple weeks, we have no way of knowing if this resolves her complaints without claims numbersWe need to know what claims for both her and her son are being referenced and who the collection calls are fromThe Revdex.com must also understand and note that there is extremely sensitive health information at handAny personal or health information should not be made publicThank you,WINhealth

Thank you for notifying us of the member complaint against
WINhealth to the Revdex.com. Our member, Ms *** ***,
enrolled with us for health insurance to begin on January 1, 2014. We
have documented that she called on 1/28/to make a payment, on
2/25/to
inquire about benefits, on 4/29/to make a payment, and a final call to us
on 6/5/stating that she would like to have her policy terminated.
Unfortunately, we are unable to terminate a members insurance from the federal
marketplace until we receive documentation from the federal government that the
member has requested termination. We received that notice in June, and
are taking the steps needed to remove the member from WINhealth
insurance. She is not responsible for the disputed amount of $179.70, and
should not be receiving any further bills from us. Thank you

Complaint: ***
I am rejecting this response because:
This is a ridiculous loop holeA loop hole created by this insurance company to get out of paying for services neededThe company provided me insurance in ***They also told me "out of state" procedures were not covered by the insuranceAfter the appeal they told me most people went to *** clinic for the this type of treatment*** is in ***, so would they have paid for the hospital in ***? What about the surgeon? Also how was I supposed to find transportation hours away? And travel for hours after surgery? I will file another complaint against the Hospital in ***, who told me this was an in network hospitalMy life was in danger, and I needed this surgery to continue livingSo the next time I am in danger of death, and I call the insurance company and they tell me the Hospital is in network, and they tell me it isI must still contact doctors I did not know I needed if they are in network? I will do the insurance company a favor and file a complaint against the doctor as well, stating he is difficult to contract withI will also file another complaint against the Hospital and surgeon, who told me there would be no trouble with win healthi do not consider this resolved at allPeople need to realize win health plays games with peoples lives for profit, and is not concerned about there customers well being at all
Regards,
*** ***

Win Health has made it extremely frustrating to resolve payment issues for a family member, who has recently been in the hospital, & had numerous tests done. The hospital has said no payments were ever received from Win Health, Win Health has said they sent a check, but will not give information to the hospital. This family member has been very ill, & spends so much time on the phone, & it's been going on for over 2 months. She is now being sent to the collections.

As Provider I was very confused when I received a letter stating that we needed to reimburse WINHEALTH for a procedure that was done early in 2015. When I called the representative was very helpful and explained that the patient really had a $2000.00 dollar deductible not a $100.00 deductible and the insurance company had paid us in error and they wanted our facility to reimburse the insurance company and then we could contact the patient to be paid the difference. This seemed odd to me. I called the patient and she was very upset as she had bought this plan on the Market place and had her procedure precertified prior to day of surgery. After talking to the patient I was convinced there was some type of error. I sent an Email to the WINHEALTH rep Amanda, She responded very quickly and researched the issues. Within 4 hours of sending the email Amanda called me with a resolution to the problem. I cannot say that I would recommend WINHEALTH , however I feel that this rep did the right thing and was very efficient in researching the problem. I want to say thanks for a job well done. I passed this information on to the patient who was extremely grateful.

Tell us why here... In order to ensure that Ms. [redacted]’s complaints are completely resolved, we need additional information. While WINhealth did reprocess and pay some of Ms. [redacted]’s claims within the past couple weeks, we have no way of knowing if this resolves her complaints without claims...

numbers. We need to know what claims for both her and her son are being referenced and who the collection calls are from. The Revdex.com must also understand and note that there is extremely sensitive health information at hand. Any personal or health information should not be made public. Thank you,WINhealth

It is clearly stated in WINhealth's Evidence of Coverage that all members receive that everyone involved in a procedure must be in-network.  This is the member's responsibility prior to having the procedure performed.  Unfortunately, anesthesiologists have been very difficult to contract...

with in WY.  Appealing the decision was the correct course of action, and there is nothing further WINhealth can do.

Complaint: [redacted]
I am rejecting this response because:This is a ridiculous loop hole. A loop hole created by this insurance company to get out of paying for services needed. The company provided me insurance in [redacted]. They also told me "out of state" procedures were not covered by the insurance. After the appeal they told me most people went to [redacted] clinic for the this type of treatment. [redacted] is in [redacted], so would they have paid for the hospital in [redacted]? What about the surgeon? Also how was I supposed to find transportation hours away? And travel for hours after surgery? I will file another complaint against the Hospital in [redacted], who told me this was an in network hospital. My life was in danger, and I needed this surgery to continue living. So the next time I am in danger of death, and I call the insurance company and they tell me the Hospital is in network, and they tell me it is. I must still contact doctors I did not know I needed if they are in network? I will do the insurance company a favor and file a complaint against the doctor as well, stating he is difficult to contract with. I will also file another complaint against the Hospital and surgeon, who told me there would be no trouble with win health. I do not consider this resolved at all. People need to realize win health plays games with peoples lives for profit, and is not concerned about there customers well being at all.
Regards,
[redacted]

Tell us why here... In order to ensure that Ms. [redacted]’s complaints are completely resolved, we need additional information. While WINhealth did reprocess and pay some of Ms. [redacted]’s claims within the past couple weeks, we have...

no way of knowing if this resolves her complaints without claims numbers. We need to know what claims for both her and her son are being referenced and who the collection calls are from.
The Revdex.com must also understand and note that there is extremely sensitive health information at hand. Any personal or health information should not be made public.
Thank you,
WINhealth