EmblemHealth

I have spent over 30 hours on the phone and several hours emailing Emblem Health regarding claims that were denied. I am one of the fortunate in that I have bridge insurance (First Health) through Emblem.

First Health participates with my out-of-state provider and covers my medical costs in full. I verified this prior to continuing to see my provider and took the time to understand how First Health worked with Emblem. We all pay enough for health care, and we dont need to take on additional medical expenses.

Shortly after my first claim was submitted to Emblem, I received a rejected claim notice in the mail. Those amounts are scary.

I logged on to the portal and found the claim and there was an email option to resubmit the claim, so I referenced the claim number, explained First Health was my bridge network and they participated with my provider and how the claim process worked. After all, who doesnt love the detail you can provide with email and the convenience is priceless. Within four hours, I received a response simply stating I didnt meet my deductible so the amount would be applied toward it. They completely ignored the information on First Health.

Oh joy. I made the first of many phone calls which average about 90 minutes. With each call, I find reps and supervisors who do not understand bridge insurance or where to find it on my account. I have had two conference calls with First Health and Emblem.

First Health has educated Emblem as to where they can find the information and validated that my provider was in fact in their network and how to submit a claim. First Health reps are amazing and educated who understand the fear of being stuck with a large medical invoice. After a successful call like that, one would think Emblem now understands and this wont happen going forward, but not a chance!

I call minimally every 6 months, sometimes two or three times about one claim because although I am averaging 90 minutes per call, I learned the reps lie to me and say they are going to submit to First Health, but they dont. They resubmit to Emblem for another rejection which triggers another 90-minute call from me.

Last month, I spent 3 ½ hours with a supervisor to be assured this wont happen again, but today another 97 minutes. They cannot make a note on my account; they cannot look at a previously submitted claim and they are all clueless about bridge insurance.

If possible, do yourself a favor and make another selection when it comes to Emblem.

I will say First Health is the best! Cheers & God Bless!

To Whom It May Concern At Emblem,

My name is _____. My Emblem ID number is _____

I called the Emblem Health Behavior Health Services phone number on 1/5/23 because I was in serious need of finding a Psychiatrist to adjust my meds.

Beacon said there was no record of me in their system. That I didnt have a active plan. When I claimed I did, they said that Emblem hadnt sent the information to them yet. I enrolled in mid-December so I dont know why it would take over 25 days to get this information to Beacon.

Beacon said they would contact Emblem and this issue would be resolved in 24-48 hours. But they also said to call Emblem back and tell them the situation as well. So I called Emblem Customer Service and this is what happenend:

1/5/23 Called Emblem was on hold for 28 minutes then spoke to Chaye who created a ticket #***** and said it would take 48-72 hours to get this enrollment issue fixed.

1/12/23 Called Emblem at 9:18 am. Still not enrolled.

They put me on hold for a half an hour and then I was disconnected.

1/12/23 Called Emblem back at 9:47 am, asked for a supervisor. They put me on hold for 30 minutes. Finally spoke to a woman named April who checked my ticket number and said my information still hadnt gotten over to Beacon Health. She said she would call the Relation Manager of Beacon and create an escalation.

Then she said she would call back by the end of the day. She didnt.

1/13/23 April called me back 24 hours late and left me a voicemail. This is a direct transcription of the voicemail:

Hi Daniel, this is April from Emblem Health. I am just letting you know that I have received an update from Beacon and they said that they have to open a ticket because they cannot locate your information in the system so they are handling the piece already.

I will just call you back once I hear something from them hopefully this will be resolved this coming Monday. Ill be monitoring your case and Ill call you back again thank you so much have a great weekend. Bye.

I still havent heard from April. Monday has passed.

Tuesday has passed.

How hard is it for Emblem Health to tell Beacon Health WHICH IS PART OF EMBLEM, that I have an active enrollment?

In the meantime I had a telehealth session with a psychiatrist to adjust my meds as I couldnt wait anymore. I paid $200 out of pocket.

Will someone PLEASE take care of this enrollment issue with Beacon for me.

Called customers service to inquire about a call received from Emblem Health.

The woman answering on behalf of Emblem asked many questions repeatedly the same questions, over and over. When I asked: 'WHY, the response was.

That is my job to ask you all these questions over and over.

I advised her that I received a call from an unknown number giving me my full name and tell me that I had to return the call urgently. I asked if she could verify the number as being an Emblem Health number. She did not know, but offered to call the number and give my information, including social security number, etc. I told, NO, plz don't.

You don't know if this is a scam. She replied. I don't know, but if they asked for your info, you should give it.

How dumb can you be? Well Emblem Health employs such a person.

How many more? Stupid is stupid does.

I know that the Epidemic has a lot of things slowed down and maybe not up to par. However, with this large and well known company they have the worst customer service skills ever.

Most reps don't know what they are doing. You would send a detail message through the web portal to have the claim reprocessed and they would deny the claim as duplicate or claim processed correctly in error. You would call back speak to a supervisor then and only then will the claims process correctly and pay out when you send the proof. You call and due to high volume calls you will get hung up on.

Appeals do not process as appeals until you call about 10 times to then wait another 30 days for them to complete. This place has been more and more disorganized. You guys are messing with peoples lively hood.

If the providers do not get paid they can not pay their staff and so forth. Get it together over there.