Wisconsin Physicians Service

I have been part of a group policy with WPS for about 8 months and it has been very frustrating. All of the confusion began when WPS was switching my policy from the 'old system' to the 'new system'. Every claim that was submitted to WPS was denied saying that I did not have an active policy, when in fact, I did. With each claim, I had to call WPS (1-800 number), explain the situation, listen to the customer service representative talk to me condescendingly assuming I had the wrong information, transfer to a representative that had access to the 'old system' all for them to finally agree to re-submit the claim. I have had over 25 claims that I have needed resolution. I often asked if there was a contact that I could call directly to deal with essentially their issue, but was denied that request. I paid over $500 a month for the policy and felt that this type of treatment should have never been. I now have new insurance, but am still receiving bills that need to be resubmitted by WPS. Overall, I understand technical difficulties and I understand that problems can arise, but to continually be treated so disrespectfully with an issue that was the result of WPS switching systems was extremely aggravating.

Review: I signed up for health insurance in June with WPS. I received a bill in July for over $800 per month for a 3 month period. I had been quoted under $100 per month. When I called to see what was wrong, on July 26, I was told that my birthdate had been inverted and that it was being fixed as we spoke. On Aug. 9th after not receiving a corrected bill, I called to check again. I was told that the error had not been fixed and then transferred to someone who could fix it. There were no employees available to speak to me, so I was again lied to when I was told that someone would call me back that day. No one did. I then emailed customer service regarding the issue. [redacted], ext 66080, called me on August 12 and left me a message informing me that the issue was being taken care of and that my account was placed on hold so that it would not go into default for lack of payment. I received a letter on Saturday telling me that my insurance was being terminated for lack of payment. This is just yet another lie from this company. I believe they are engaging in insurance fraud and are discriminating against me for fighting them regarding a pre-existing condition.Desired Settlement: Billing adjustment and an apology.

Business

Response:

I'm writing this letter in response to your letter dated September 4,2013, concerning [redacted] and a complaint that she filed with your office. Because your letter did not contain a signed authorization in writing, which was a valid authorization, executed by [redacted], which authorized us to disclose to you the confidential information that will necessarily be provided in our response to the concerns she expressed in her complaint, I'm unable to provide that information to you. Thus, I've written a second letter, addressed to [redacted] containing that confidential information, which responds to the concerns expressed by Mr. [redacted]. Upon our receipt of an authorization from [redacted] authorizing us to release a copy of our letter to him to you, we will do so accordingly. If you have any questions or wish to bring additional information concerning this matter to our attention, please write to me at the address shown below.

Thank you

Regulatory Specialist

Wisconsin Physicians Service Insurance Corporation

This company has some of the poorest customer service I have ever encountered...bar none. They look for ways to deny a claim. They re-did their website and make all previous EOB's and history unavailable to the customer and gave absolutely no advance warning to the customer. They changed their claim address to some place in Texas and did not even notify any of their providers. They use Express Scripts for drugs and that is a nightmare in and of itself. Those two companies were made for each other. One is inept as the other. When you call WPS, their first and only priority is to tell you a lie just to get you off the phone so they can try to placate the next irate customer...Avoid this company at all costs.

Review: I WENT FOR MY YEARLY CHECKUP WITH MY OPHTHAMALOGIST FOR A ROUTINE EYE EXAM. I HAVE THIS DONE EVERY YEAR AND THE INSURANCE COMPANY PAYS THIS IN FULL NOT SUBJECT TO DEDUCTIBLE OR COINSURANCE. THIS TIME, WPS DENIED PAYMENT SAYING THE EXAM WAS NOT ROUTINE. I CONTACTED THE PROVIDER AND THEY RE-SENT THE CLAIM SHOWING A "ROUTINE DIAGNOSIS" TWICE BY MAIL AND ONCE BY FAX. WPS SAID THEY RECEIVED THE NEW CLAIM. SINCE THEN THE INSURANCE COMPANY STILL REFUSES TO PAY THIS CLAIM. I BELIEVE THAT WPS IS REQUIRED TO PAY THIS UNDER THE TERMS OF THE CONTRACT AND/OR THE NEW HEALTH REGULATIONS. MEANWHILE, I AM BEING BILLED BY THE PROVIDER. WPS CUSTOMER SERVICE IS AMONG THE WORST I HAVE DEALT WITH.

Claim [redacted]

Date of Service: 8-16-13

Provider: Dr [redacted]. -OptivisionDesired Settlement: WPS should pay this claim to the provider

Consumer

Response:

I filed a complaint online against WPS Insurance of Madison over

the weekend and at the same time I filed a complaint with the Wisconsin

Insurance Commissioner for a claim they would not pay. Please be

advised that they received the complaint from the Insurance Commissioner

today and they called me immediately to pay the claim. So the case has

been resolved. Thank you.

Review: I switched to WPS in March 2012 because my previous health insurance at that time had gone up from $55 to $184 per month in what I considered a short time (with no health conditions and no claims ever). When I switched I asked what the rate of increases would be. I was told: the policy would increase once on my 45th birthday (coming up two months later) and not again for several years. It sounded reasonable so I proceeded with enrollment (at $135/mo). Within 10 months my monthly premium had increased twice by a total of 38% (to $184 again). I was furious after I was notified of the second increase but could not do anything about it as I was about to leave for a volunteer position overseas (in Asia) for 6 months. I felt lied to and manipulated.

By the time I returned I had been offered a job in Europe, and left within a month or so. This past weekend I got my residency, which means free health insurance coverage. I called today to cancel my WPS policy and was told I would be billed for another two weeks because "it's policy." When I complained that it is not standard protocol to bill for services denied (because I am canceling/denying coverage effective immediately), Brittany (888-527-0586 member services extension 65611) said it is written in their policies somewhere which she could not email me nor find on the website. I strongly object to being charged for services I am not using. I am used to canceling my insurance coverage and being refunded overpayment effective to the date of cancellation. It sounds to me like a very low-integrity concept (which I have no proof of legality) which would also mean that if I wanted to make a claim in the next two weeks, I could, since I was being billed for coverage. This does not sound correct or legal to me.Desired Settlement: I want the billed coverage to reflect actual coverage. Billing does not actually occur until the 16th but she said I would be billed anyway for the full amount and later refunded half, allegedly, even though I canceled today, on the 15th. I am really disgusted by this and feel like I am being extorted. If you can help, I would sincerely appreciate it because logistically I am no longer in Madison and it is 10 times more difficult to address this issue. My address and phone listed are my mother's (my permanent US address for tax and other purposes).

Thank you for any assistance you can offer.

Sincerly,

Lori Doyle

[email protected]

Review: Insurance Company still has not sent ID cards or policy information and will be taking the THIRD monthly premium in two days. I called to get this information sent and still have to wait 7 to 10 more business days. We should not have to pay premiums if they can't get this information to us in a reasonable time.Desired Settlement: I should be refunded the premiums for the two months I did not have insurance cards and policy information. We applied on January 15th.

Business

Response:

I'm writing this letter in response to your letter, dated March 26,2014, concerning Ms. [redacted] and a complaint that she filed with your office.

Review: The insurance company has not paid $364.80 for ECG ordered by my doctor on 11/12/2014 with diagnosis code V70.0 (routine annual exam). Till June 18, 2015, the insurance company always stated that the reason of not paying is wrong diagnosis code from the hospital. Even the appeal reply of the insurance company clearly stated that the only reason of non-payment is wrong diagnosis code from the hospital. When I made sure that the code is right and the hospital has sent the right code of routine annual exam, I received a letter dated July 28, 2015 from the insurance company stating ECG is not part of annual routine exam.Desired Settlement: The insurance company pays me $364.80. The insurance company should not keep on changing its statements.

Business

Response:

I am writing in response to your letter, dated August 12, 2015, concerning the processing of charges for services provided to Mr. [redacted] on November 12, 2014.At the time of the claim in subject, the patient had coverage under a Health Benefit Plan that was self-insured/funded by Mid-State Technial College for its employees. Within a self-insured plan,the employer pays for all medical expenses that are covered under the Health Benefit Plan ("Plan") The Plan was administered by WPS Administrative Services, a division of Wisconsin PhysiciansService Insurance Corporation ("UWPS"), based on an Administrative Services Agreement ("ASO·) between Mid-State Technical College and WPS.On December 31,2014, the Plan and the ASO agreement between Mid-State Technical College and WPS terminated. As part of the ASO agreement WPS continued to process claims for thefollowing six months for dates of service incurred during the effective dates of the Plan and the ASOagreement. WPS processed claims until June 30, 2015. Under the ASO agreement, WPS processed claims and appeals for six consecutive months following the termination of the agreerrment. The exhaustion date for that portion of the ASOagreement was December 31, 2014, with an extension agreement that exhausted on June 30, 2015.Since all medical expenses covered under the Plan were paid for by Mid-State Technical College, and the Plan has terminated its ASO agreement and terminated the subsequent agreement withWPS, we will not make any adjustments to the claims regardless of the dates of service.The patient may submit the claim to the new claims administrator for consideration under the Plan.Sincerely,[redacted]

Consumer

Response:

Review: I changed my health insurance coverage in August of 2013. I was told I didn't need to do anything and everything was taken care of on their end. The first issue stated with WPS withdrawing money for their monthly payments from my bank account for the old insurance coverage as well as the new insurance coverage. I received an overdraft notice and fee from my bank. I had to call WPS for them to fix this issue. I was told that it would be taken care of. I then had to resolve the issues with the overdraft fees from the bank on my own even though it wasn't my error. My second issue is that all of my insurance claims keep being sent to my old insurance number and I was told that I didn't need a new insurance card. So I have to call every time I receive a letter from WPS that the claim is denied. They tell me that they see the problem and then they pay the claim but never fix the issue on their end. My chiropractor has called and leaves messages with their billing department and never receives call back. I have called them many times to resolve the problems and they tell me on the phone that they have and in actuality it isn't fix.

As of today, February 13. 2014 my claims are still being processed through my old insurance number and I have to call every time I go the doctor to make sure that the claim is sent to the correct insurance number.Desired Settlement: I would like to get the issue resolved indefinitely.

Business

Response:

I'm writing this letter in response to your letter, dated February 13,2014 concerning Me Hady and a complaint that he filed with your office.

Because your letter did not contain a signed authorization in writing, which was a valid authorization, executed by Mr Hady, which authorized us to disclose to you the confidential

information that will necessarily be provided in our response to the concerns in his complaint, I'm unable to provide that information to you. However, we addressed Mr Hady's concerns

in a separate February 27, 2014 letter to him. Upon receipt of an authorization from Mr Hady authorizing us to release a copy of our February 27, 2014 letter to him, we will do so accordingly.

If you have any questions or wish to bring additional information concerning this matter to our attention, please write to me at the address shown below.

Thank You

Sincerely,

Kimberly ZCole

Regulatory Specialist

During open enrollment in October WPS lied to us multiple times to get us to sign up for their health care!!! We did not know of the lies until January 1, 2016 when our insurance cards came in the mail and we had no coverage in the state we lived!! They lied to get their money and when I called for help, they laughed at me!!

This company instructs employees to process claims illegally.

This is some of the worst customer service I have ever experienced. You call with a billing question they tell you it is taken care of only to find out it hasn't. Each time you call you wait on hold for 20 to 30 minuets only for them to tell you they will take your number and call you back. Then they don't. Finally they put me on a "priority list" to call me back. Are you kidding me what a joke! This has gone on for a month and a half now and is still not resolved.