Harvard Pilgrim Health Care

In the last week, 4 calls, I have been placed on hold as little as 14 minutes and today I was on hold for 27 minutes. Prior to leaving Blue Cross, we spent 2 months talking to their sales nurse and customer service and were assured that my chronic condition medical needs would be seamless. They just denied my pain meds. No substitute offered. My doctor says no substitute is available. Their response. We have denied and now you need to appeal. They use as third party prescription company to determine medical needs. When asked if any of the members of the prescription company were board certified doctors, they respond «unknown» My pain specialist has 2 board certifications.

Just about the worst health care coverage I have ever had. Reset deductibles every six months for the past three years (yes, I know it’s an illegal practice and they will be reported to the MA insurance commission shortly). Claim processing very slow, inconsistent, and convoluted. It seems there’s always a out of network process on the claims submitted, when we have verified the provider is in network prior to visit. Just awful! Wish my employer had never switched. I don’t have anything good to say about my experience with this company.

I called Harvard Pilgrim to cancel my policy. They said I needed to fill out a form and send it in. I set the date of my cancelation for August 1, 2015. They say they didn’t receive the form until August 6, 2015. After that date they decided to pay a provider that had submitted a claim by mistake. So now they want me to pay for the whole month of August because they paid the claim by mistake. I asked to have the mistake corrected but they can’t do that. They can only take more of my money.

Harvard Pilgrim is refusing to pay for a claim over 12 months old. They originally had denied my claim because they needed «additional information» and it was for a simple check up. What other additional information do you need? Why didn’t you call me about this? I was a student and didn’t receive any letters from Harvard Pilgrim. The customer representative bluntly told me they won’t pay for the cost because its been over 12 months (seems like he was used to saying this). I had to buy this plan because I didn’t have health insurance and didn’t have much money as a student. I guess they knew that students were vulnerable because their always so busy. Now that I’ve been through their services and have a very good paying job, I will never get insurance from them again.

I too would give ZERO stars if it was allowed. I work for a provider and Harvard Pilgrim is BY FAR the worst insurance company to deal with. Their provider service department is basically paid to tell you they will «take care of things» when contacted about claims that THEY processed incorrectly due to THEIR errors… then they take up to a year or longer to resolve any issues, if ever. The appeals department is no better. Appeals take 9+ months to review (even though if we don’t file a claim within their timely filing limits, forget it) and often are reprocessed incorrectly resulting in need for a second-​level appeals. Their commercials stating they are the #1 insurance company just make me angry– the only reason they are #1 is because they DON’T PAY for services so they come out on top. Things have gotten so bad we are considering filing a chapter 93A with the Insurance Commissioner against them. Send me a message if you want in!

So I have United Healthcare/​Harvard Pilgrim insurance and this is the third time this year they’ve refused to cover something they are clearly supposed to cover.
1^st time: standard lab as part of prenatal care. They say it’s not standard, not the right codes, blah, blah, blah. Mass General Hospital even called them and tried giving them other codes, telling them it’s standard preventative care, etc. No beans. I still had to pay it.
2^nd time: my husband had a routine primary care checkup. First, this should be covered anyway because 1 primary care visit per year is free. They refused to cover it due to a billing error that doesn’t recognize the location as in-​network. Seriously, I checked the status of the office online before my husband even went, didn’t matter. I called the Dr’s office and they said all of their UnitedHealthcare/​Harvard Pilgrim patients were having the same issue.
3^rd time: My daughter went to Boston Children’s — but at a satellite location. I was wary due to the previous problems, so I called the insurer ahead of time to verify that the doctor and the location were in-​network. Lo and behold, a $ 1000 bill, charging me for out-​of-​network care. The reason? Although the doctor is covered, and the location is covered, the doctor is not covered at that location. Ha.
It’d be kind of sickly humorous if I didn’t have to pay the bills in the end. All this in a year where we already met our out-​of-​pocket maximum (giving birth will do that), so everything ought to be covered. I’m planning on filing an appeal/​complaint with a 3^rd party arbitrator, but I really shouldn’t have to go through this mess.
While they are accepted pretty much everywhere, that doesn’t matter if they won’t cover your care. Everyone I’ve talked to is very nice on the phone, but you don’t get anywhere as far as I can tell. I’d advise people to be very careful to verify that they will cover something ahead of time, and make them put it in the notes on your account that you talked to them about it.

So according to Harvard Pilgrim they can drop your Primary Care provider on a dime, never notify you, and you’re responsible for all the charges. After trying to appeal this with Harvard Pilgrim their response is we should check with them daily to ensure the doctors we have been seeing for years (which they have record of) are still covered and that «you are responsible to make sure that you receive care from a specialist and facility who participates in the Primary Choice Plan.» Apparently it’s NOT their job to notify customers of such changes, their letter refers us to their online directory where I found several providers listed as «covered» but found that they were not. What a great scam. Drop people’s primary care doctor; don’t notify you or your doctor, save the company some money.
Basically they dropped my 2year old daughter’s PC on January first and we took her the first week of January. They never notified us and her doctor wasn’t notified either. After trying to appeal this with HP they have denied the claim and said we are SOL. I will never use Harvard Pilgrim again.
~Stefan

As a provider that does business with Harvard Pilgrim I can say that they are one of the worst insurers to deal with. They will avoid payment by any means they feel possible and the reasons are not rational. They make providers jump through many hoops of administrative tasks which are costly and time consuming and if they pay, they pay under what is our cost to provide the service. Stay away from Harvard Pilgrim. It is better to have no insurance than them. Providers like myself are choosing not to do business with them.

What a horrible insurance provider. I was forced to move from United Health Care to HP. I didn’t think it would be too bad since I’m not in the New England area and they claim they use United Health Care for outside the NE area. The first time my family needed something besides of a normal doctor’s visit they denied it. My son needed an MRI and they wanted him to do 4 weeks of physical therapy before they would approve the MRI. Basically, suck up the pain for 4 week before we shell out any money.
I would go back to United Health Care as the primary and never deal with them again if I had the choice.

Janice F… Harvard Pilgrim isn’t responsible for the amount of money you pay your employer each month as your health care premium. Companies decide for themselves how much of the Monthly premium THEY will pay and how much YOU will pay. Perhaps your employer elects to only cover 20% of the health care premium for the plan that you select but your friends employer covers 50%. You could be paying more money for the same plan as your friend and HP has nothing to do with it. BTW not only to employers decide how much money they will contribute towards your health care benefits, but they also pick the level of benefits Harvard Pilgrim will cover in your plan. So… you can pay alot of money or a little money each month for your Health Care Plan and you can have great coverage (say $ 10 deductibles) or terrible coverage ($ 50 deductibles) — who should you turn to to complain… ask your employer.

I would put zero stars if I could. Seriously evil and greedy company. Don’t cover the cost of colonoscopy if you have polyps removed, which of course means you are higher risk of cancer, so they make you pay the full cost which is of course a dis-​incentive to get preventative care. Thus they get around complying with health care reform. I haven’t taken the time to research their surplus for the last year, but I am sure it is in the $millions.

Wooo! I’m first to review!
While premiums might be high, most places take this insurance, so you’re safe with pretty much any medical need. They cover what they say they cover. They’ve never ever rejected anything (well, ok once they did but that was my doctor’s fault, not the HPHC’s! And my doctor fixed it right away and HPHC was happy to cover said medical thing right away)
The drawback: I wish you can pay your bills online. Their billpaying system is quite antiquated, as you pay by check and wait for it to clear. I don’t like sending these checks as the amount is pretty high and they don’t take certified mail. They do give an option to debit your premium from your bank account, but have to fill out some kind of form to get your bill automatically debited, and they still have yet to send me this form. Make sure you really monitor your checks when you pay because, well, sometimes they lose checks. My husband is the billpayer of the family so he deals with their bureaucracy and I don’t, so he dealt with them with the ‘lost check’ situation. (to be fair, this happened once in three years, but it was still annoying!) FYI– they don’t like talking to husbands about account situations as they sputter things like HIPPA and ‘well some people will talk to spouses’- so yeah, sometimes the customer service/​billing people are difficult, which equals the minus one star.
Also to be fair, they don’t report bills to collection agencies, which is something they tried to make us feel better with when they lost our check, which really didn’t make us feel better since we PAID the bill and are not ones to get bills sent to collection agencies anyway.
I also want to say that they do seem to care about their customers. They called me after I was hospitalized (thanks to stomach cancer, consequent surgery) to see if I was OK and told me they had resources for cancer patients (on call nurses) in case I needed anything when MY on call nurses weren’t around. ½ of me was flattered with their niceness ½ of me was suspicious by their niceness (maybe they were wondering how much more they had to pay for me? I don’t know… they fork a LOTTA money over for me!).
Don’t get this kind of insurance unless you will DEFINITELY USE it (unless maybe they have plans that are cheaper? I don’t know, i pay over $ 440 a month). I see lots of specialists, get tests, blah blah blah, so the amount I pay per month equals out to the amount HPHC pays; in fact, they pay more. They either love me for my business or cry every time they see a hospital bill from me.
ANYWAY, I RELY on this insurance pretty much for my LIFE and it’s always there for me. So thank you HPHC! Do something about your billpaying though and please don’t lose any more checks! We like paying you, believe it or not!!! !!!