Sendero Health Plans

Complaint: [redacted]
I am rejecting this response because I feel that more notice should have been given that the account was to be cancelled other than one letter sent to the wrong address. Why could I still log on to Sendero to pay $240 six weeks later? No message came up that the account was closed, no phone call or email received. Nothing.... I feel that any other business tha accepts payments online would have had some type of indication that the account was overdue or even closed. 
I did receive a refund for the $240.00 and am still waiting on the rest of the refund that will be sent in the form of a check. 
Regards,
[redacted]

IdealCare by Sendero Health Plans (IdealCare) has reviewed the complaint submitted by [redacted]. Mr. [redacted] is requesting a full refund for the month of January as he was not able to utilize his insurance.   The consumer was contacted on 02/01/2018 by the Member Advocate to...

obtain additional information regarding the complaint submitted. Per Mr. [redacted], he was not able to utilize his health insurance, because he did not have an insurance identification card. He stated he tried to contact IdealCare Customer Service and was not able to speak to reach anyone to assist him. The Member Advocate offered to reimburse the consumer for any out of pocket costs he acquired due to the fact he was not able to utilize his health insurance benefits. Mr. [redacted] did not want to provide any information on the services he paid out of pocket, and the Member Advocate informed Mr. [redacted] that she would escalate a request for him to receive a credit in the amount of his premium for January.   On 02/02/2018, the consumer was contacted and advised that his account would be credited for one month of premium. Mr. [redacted] was satisfied with the outcome, and he did not have any other questions or concerns.   Sendero understands how important member experience and satisfaction is.  We will use this situation to assist us with improving our processes going forward.                                           ...⇄ Again, thank you for the opportunity to respond to this concern.

T
font-size: 11pt;">hank you for the opportunity to address the concerns mentioned within this complaint.
 
Sendero Health Plans’ (Sendero) Member Advocate spoke to Ms. [redacted] on January 11, 2017. After speaking to Ms. [redacted], she stated that she was concerned as she had not be able to reach our Customer Service Department last week. On Tuesday, Ms. [redacted] received a voicemail asking if she wanted a call back from our Customer Service Department’s automated system do the overwhelming number of calls being received.  Ms. [redacted] responded that she did want a call back, and a Customer Service Representative called her. She stated that she did need additional assistance with obtaining an appointment with a primary care physician, and she was assisted and an appointment was scheduled.
 
Ms. [redacted] confirmed that her premium is $4.90 not $650.00. Ms. [redacted] was satisfied with the follow up she received, and did not need any additional assistance. Ms. [redacted] also stated that she would remove the complaint as she was satisfied with the outcome.

Complaint: [redacted]
I am rejecting this response because I feel that more notice should have been given that the account was to be cancelled other than one letter sent to the wrong address. Why could I still log on to Sendero to pay $240 six weeks later? No message came up that the account was closed, no phone call or email received. Nothing.... I feel that any other business tha accepts payments online would have had some type of indication that the account was overdue or even closed. I did receive a refund for the $240.00 and am still waiting on the rest of the refund that will be sent in the form of a check. 
Regards,
[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.   THANK YOU FOR YOUR HELP!
Regards,
[redacted]

Thank you for the opportunity to address the concerns mentioned within this complaint.  Sendero Health Plans’ (Sendero) Member Advocate attempted to contact Mr. [redacted] on 4/13/2017.  Our Member Advocate left a voicemail requesting a return call. On 4/14/2017, the Member Advocate was able...

to reach Mr. [redacted] who was concerned that his payments had not been posted to his account. Per Mr. [redacted], his bank mailed Sendero four checks: one on 12/16/16 for $378.99, 1/17/17 $378.99, 2/21/17 $89.82 and 3/21/17 $468.81.   After review, Sendero’s Finance Department concluded that the checks mailed on 12/16/16 for $378.99 and 1/17/17 for $378.99 were sent to our previous / old lockbox, but both payments have been posted to the Mr. [redacted]’s account. In regards to the checks mailed on 2/21/17 for $89.82 and 3/21/17 for $468.81, those payments have not been received.   On 4/18/2017, the Member Advocate spoke to Mr. [redacted], and explained that the checks sent on 2/21/17 and 3/21/17 had not been received. Mr. [redacted] was advised that he will need to reach out to his bank and request a stop payment on both checks. At this time, Mr. [redacted] confirmed that both outstanding checks had not cleared his account.   Mr. [redacted] expressed dissatisfaction in regards to the fact that Sendero had not received the outstanding payments. The Member Advocate explained that Sendero cannot credit the account, because his payments had not been received.   On 4/24/2017, Mr. [redacted] contacted Sendero, and stated that his bank reissued a check for $468.81 on 4/20/2017. As of today, Sendero has not received the payment, but as soon as the payment is received Sendero will notify Mr. [redacted].   Sendero understands how important member experience and satisfaction is.  We will use this situation to assist us with improving our processes going forward.     Again, thank you for the opportunity to respond to this complaint.   Sincerely, The Member Services Team

March 8, 2016

Roman">
[redacted]
Revdex.com Corporate Office
1005 La Posada Drive
Austin, TX 78752



On March 2, 2016 Sendero Health Plans (Sendero) received complaint ID [redacted] which was filed with the Revdex.com on February 24, 2016. We appreciate the opportunity to respond and provide you the resolution to the complaint presented.

The complainant obtained active health coverage with Sendero on January 1, 2016.  On February 24, 2016, the complainant contacted Sendero for a refund for January due to her termination request.  Sendero directed the complainant to also contact the Marketplace/CMS in order to complete her request to terminate her coverage. 

As of today, the complainant has not paid a full month’s premium.  Sendero’s process is to mail ID cards and member materials once the member has paid their monthly premium in full.   Subscribers who have not paid their premium in full will only receive an invoice and a welcome letter which explains payment directions, options and locations. The complainant did not receive her ID cards due to her January balance.  Therefore, no claims are on file for this member as she did not receive an ID card to receive services. 

The complainant’s health coverage will be canceled on March 10, 2016 per CMS’s direction and not January 1, 2016 as the complainant requested.  On February 25, 2016, CMS sent Sendero a file with direction to terminate the member effective March 10, 2016. 

Sendero understands how important member experience and satisfaction is.  We apologize for the inconvenience the complainant experienced, and we will use this situation to assist us with improving the process going forward.

Again, thank you for the opportunity to respond to this complaint.

Sendero Health Plans

This is a terrible company. It takes forever for them to answer the phone, IF indeed they ever do. They have no idea how to lookup standard medical coding. So when you get scheduled for a mammogram screening, it is likely NOT going to be covered if the doctors office used the wrong code. Sendero has no idea what the right code is and cannot provide any information on how to correctly get things coded for routine wellness exams. This company is a sham. Don't waste your money buying ANY coverage. The doctor's facilities they cover are a nightmare and severely limited.

April 14, 2016 [redacted] Revdex.com Corporate Office 1005 La Posada Drive Austin, TX 78752 On April 6, 2016, Sendero Health Plans (Sendero) received complaint ID [redacted] which was filed with the Revdex.com on April 5, 2016. We appreciate the opportunity to respond and provide you the...

resolution to the complaint presented. The complainant obtained active health coverage with Sendero on January 1, 2016 per the CMS enrollment file received on November 19, 2015.  The complainant was mailed an initial invoice on December 1, 2015 for the total premium amount due of $183.21. The complainant paid $169.36 of the monthly premium due on January 26, 2016.  The balance remaining was $13.85.  Subscribers receive their enrollment packet along with ID cards once the first full month’s premium is received.  On February 2, 2016, the complainant contacted Sendero’s customer service department and confirmed that the $169.36 payment was received.  On February 16, 2016 Sendero followed up with the complainant to notify her of the outstanding balance on her account.  The complainant stated that her effective date should have been March 1, 2016 and that her premium should be less due to her plan change via the Marketplace. The complainant’s premium change was later received by CMS for $169.36.  The complainant was mailed an invoice for March with the appropriate amount due. The complainant was canceled for non-payment on March 22, 2016 per CMS guidelines. Sendero reminded staff to provide balance information upon contact with subscribers when they provide premiums received /posted or any other request that are made during the communication.  Sendero attempted to contact the complainant via three different phone attempts to address to this concern. At the time of this notification, the complainant has not followed up to the voicemails left requesting a return call. Sendero understands how important member experience and satisfaction is.  We will use this situation to assist us with improving the process going forward. Again, thank you for the opportunity to respond to this complaint.

Complaint: [redacted]
I am rejecting this response because: This is not at all what I was told on the phone by ideal care before going to the ER. In addition, their policy says doctors may balance bill, but it implies that they will cover all hospital bills, and this is what their representative said. In addition, Texas law says that insurance companies must pay for out of network emergencies to that the enrollee with not have to pay more than if it was an in network provider. 
Regards,
[redacted]

Good morning, My apologies for the delay. I was finalizing Sendero’s response when I received the below notification. Please find the attached complaint response. Thanks,[redacted], MHA • Director of Operations[redacted]Tel: [redacted]...

[redacted]

Complaint: [redacted]
I am rejecting this response because: the issue is still not resolved. They claim to not be receiving the payments from the bank but based on the unprofessional nature of the handling of all payments so far it seems more likely they have received the payments but have lost them. The bank has not just re-issued the payment stated by Sendero in this response but both payments in question were resent. Still waiting for them to credit my account fully so I don't know why they are even updating this complaint as it's not resolved.
Regards,
[redacted]

Thank you for the opportunity to address the concerns mentioned within this complaint. Sendero’s Member Advocate spoke to Ms. [redacted] on 3/8/17 in regards to her complaint after unsuccessful attempts on 3/2, 3/3, and 3/6. After speaking to the Ms. [redacted] she stated she received her ID cards and...

welcome package; the family is actively enrolled with Sendero effective 1/1/2017. Ms. [redacted] also received her premium invoice that was mailed on 12/3/2016 which also included the family members enrolled with Sendero. In regards to the claim that was denied for her spouse, there was one claim denied. The claim was denied because it was a duplicate claim. After clarification, at the end of the call Ms. [redacted] did not have any other issues or concerns. Sendero understands how important member experience and satisfaction is. We will use this situation to assist us with improving our processes going forward. Again, thank you for the opportunity to respond to this complaint. Sincerely, The Member Tell us why here...

Thank you for the opportunity to address the concerns mentioned within this complaint. Sendero Health Plans’ (Sendero) Member Advocate spoke to Mr. [redacted] on January 19, 2017. After reviewing his account, we confirmed that he is not enrolled in our automatic bank draft process for IdealCare...

healthcare benefits. Mr. [redacted] is in enrolled in autopay with his bank which means that every month his bank would mail IdealCare by Sendero Health Plans a check for his health coverage. We did receive a check on 12/29/2016 for $531.33, and this payment went towards his 2016 account.  This payment cleared his account on 1/18/2017. We explained to Mr. [redacted] the issue, and we advised him to contact his bank to initiate the process to stop the autopay if he is going to utilize IdealCare’s other payment methods to make his monthly premium payment.  We also asked the member if he wanted a refund or a credit of $531.33 to be applied to his February invoice, but he stated that he preferred a refund. We advised the member that we will mail him a refund check, and it can take about two weeks for him to receive it. At the conclusion of the call, Mr. [redacted] was satisfied, and there was no further action needed. Sendero understands the importance of member satisfaction.  We will use this situation to assist us with improving our processes going forward.   Again, thank you for the opportunity to respond to this complaint / concern.

February 9, 2016 [redacted] Revdex.com Corporate Office 1005 La Posada Drive Austin, TX 78752 On 2/1/2016, Sendero Health Plans (Sendero) received complaint ID [redacted] which was filed with the Revdex.com on 1/28/2016. We appreciate the opportunity to respond and provide you the...

resolution to the complaint presented. The complainant was enrolled with Sendero effective 5/1/2014.  Sendero mailed the subscriber two invoices which totaled $494.44 to ensure continued coverage.  The complainant’s health coverage was later canceled for non-payment on 8/31/2014 per CMS guidelines.  The subscriber does not have a balance with Sendero for the 2014 benefit year. On In January 2016, CMS sent Sendero an enrollment segment for 2016.  The subscriber was sent an invoice due to the active enrollment segment sent from CMS.  After the subscriber contacted CMS, CMS provided Sendero guidance to terminate the current coverage for the subscriber effective 2/12/2016. Sendero staff contacted the subscriber on 2/4/2016 at 4:58 PM regarding this concern.  On 2/9/2016 at 12:30 PM Sendero staff spoke with the subscriber and confirmed no payment is due.  In addition, the subscriber was ensured that Sendero received the term segment from CMS for the 2016 benefit year and no payment is due. Sendero understands how important member experience and satisfaction is.  We apologize for the inconvenience created due to the subscriber receiving an invoice, and we will use this situation to assist us with improving the process going forward. Again, thank you for the opportunity to respond to this complaint and assist the subscriber.

Concern: The member/subscriber is seeking clarification for the Silver Complete 87% plan vision benefits offered by IdealCare.
 
Explanation: The PDF copy of the Summary of Benefits for the Silver Complete 87% AV plan states "Routine Eye Care (Adult) — limited to 1 exam...

per year". This PDF copy is located on the Sendero website. Members of all ages are eligible for one eye exam per calendar year after copaymenticoinsurance, if applicable. Members under 19 years of age are eligible for one pair of eyeglasses, or an initial supply of contact lenses, in lieu of glasses every calendar year. Eyewear for members over the age of 19 is not a covered benefit.
The Evidence of Coverage, Complete Essential E0C, excludes eyeglasses or contact lenses, provided that intraocular lenses shall be specific exceptions to this exclusion; or examinations for the prescription or fitting of eyeglasses or contact lenses, except as may be provided under the Benefits for Routine Exams and Immunizations section of the EOC.
The Schedule of Coverage explains that an annual vision exam is covered for children and adults, 100% of allowed amount after a $0-$50 copayment per visit. The Schedule of Coverage also explains that annual prescription eyewear is covered for children only and 0-50% of allowable amount after calendar year deductible.
Unfortunately, the vision 'drop down' option via the Sendero website states 130 copay per eye exam visit and 10% coinsurance for glasses after deductible is met". The website did not state glasses are covered for children under the age of 19 only.
Outcome of the Action Plan:
Sendero Health Plans reviewed the sound wave from the member call. The member mentioned during the recorded call that a provider informed the member that he did not have vision coverage. The Sendero CSR immediately apologized for the miscommunication that occurred between the unknown provider and member. The CSR informed the member that he is covered for one routine eye exam via the benefit plan he enrolled in. The member informed the CSR that the Sendero website states that members are covered for visions exams and glasses. The CSR explained that glasses are not a covered benefit for adults, and the member said 'thank you' for the information.
Sendero Health Plans initiated a plan of action to prevent this miscommunication from occurring again in the future. The Sender() website has been edited to reflect that benefit for glasses is only for children under the age of 19. Also, Sendero
Health Plans will add the same clarification to all of the Summary of Benefits distributed and available to members. Lastly, Sendero Health Plans reached out to the member to clarify the benefits, discuss how to make his premium payment, and the process to receive ID cards and welcome packet materials. The member was not able to speak at the time the call was made, and the member instructed he will contact the plan when he was available.

Complaint: [redacted]
I am rejecting this response because: they did not clearly communicate any of this information to me, clearly. The right hand does not know what the l ft hand is doing in their offices. 
They falsified their records. My phone has not been disconnected, has never been disconnected. They did not record all of the times I called and was given incorrect information. Also, in regards to the coverage question, this was not the first time I had called to ask about my coverage. I spoke with an individual in April who confirmed that a procedure would be covered. It was not. This was for a colposcopy I had to have performed. My husband and I ultimately decided it would be easier to just not pay out insurance bill and get cancelled as opposed to dealing with Sendero any longer. This experience has been terrible. I have never worked with such an awful insurance company before.
Regards,
[redacted]

Their website shows wrong amount of premium. I have been calling for months to fix it, I wait on the line for 45 minutes and then the system says "There is nobody to answer your phone, please leave a voicemail". I have not received my ID card and coverage because of their sloppy service. I left 7 voice mails, nobody returned my calls. I am so hopeless. I don't know what to do now...

April 14, 2016

Roman">
[redacted]
Revdex.com Corporate Office
1005 La Posada Drive
Austin, TX 78752



On April 6, 2016, Sendero Health Plans (Sendero) received complaint ID [redacted] which was filed with the Revdex.com on April 5, 2016. We appreciate the opportunity to respond and provide you the resolution to the complaint presented.

The complainant obtained active health coverage with Sendero on January 1, 2016 per the CMS enrollment file received on November 19, 2015.  The complainant was mailed an initial invoice on December 1, 2015 for the total premium amount due of $183.21. The complainant paid $169.36 of the monthly premium due on January 26, 2016.  The balance remaining was $13.85.  Subscribers receive their enrollment packet along with ID cards once the first full month’s premium is received.  On February 2, 2016, the complainant contacted Sendero’s customer service department and confirmed that the $169.36 payment was received.  On February 16, 2016 Sendero followed up with the complainant to notify her of the outstanding balance on her account.  The complainant stated that her effective date should have been March 1, 2016 and that her premium should be less due to her plan change via the Marketplace. The complainant’s premium change was later received by CMS for $169.36.  The complainant was mailed an invoice for March with the appropriate amount due. The complainant was canceled for non-payment on March 22, 2016 per CMS guidelines.

Sendero reminded staff to provide balance information upon contact with subscribers when they provide premiums received /posted or any other request that are made during the communication. 

Sendero attempted to contact the complainant via three different phone attempts to address to this concern. At the time of this notification, the complainant has not followed up to the voicemails left requesting a return call.

Sendero understands how important member experience and satisfaction is.  We will use this situation to assist us with improving the process going forward.

Again, thank you for the opportunity to respond to this complaint.

This is the WORST company to try to get a hold of, and they are a health insurance company. What is more important than your health? Nothing! You can NEVER reach them, IF you stay on hold for the hour you have to wait you ALWAYS reach the wrong department and they give you a different phone number to call. I have 10 DIFFERENT phone numbers for this company and I still can't reach them. I have also paid my premiums but haven't received my health insurance card and my information isn't recognized in their system, yet the took my money and show that they took my money. I need to go see a doctor but cannot get ANY information on my policy so I can go see a doctor. I have been on hold (right this very moment) for over an hour and a half!