Meritain Health
Reviews and Complaints

I have never in my life been treated so poorly by an insurance agent. To the point where I even had to ask her why she was being so rude, and speaking to me the way she was when I wasn't being rude or disrespectful to her.

She continued being rude after that and basically said to have the hospital call her instead because they would actually understand what was happening. Everytime I asked a question or tried to understand something, she would huff and sigh really loud and say "hold on" in a very rude voice. I know everyone has bad days but this was completely unacceptable! Especially after I even asked why she was being so short with me and she continued to do it!

I called back and had someone else help me after that.

He was super helpful and polite. No issues at all with him!

Im convinced this company will do anything to get out of paying their claims. Ive had nothing but issues since my husbands company switched from highmark to meritain health 2 years ago.

Claims processing wrong CONSTANTLY. Its an actual scam company and I feel bad for employees who get screwed with this insurance as their only option. They should be shut down and Aetna should be absolutely ashamed of themselves for creating this nonsense just to save a dime.

You are saving money by making hardworking Americans foot the bill for things they shouldnt have to. If you plan to use your health insurance at all DO NOT go with meritain.

In working with Meritain on mutual client (a Plan Sponsor of Group Medical Plan) for whom Meritain is the claims administrator, the service representatives have taken months to respond to each audit requests for claims data and supporting documents. This has occurred in both years I've worked with them.

This resulted in delaying the plan's audit and Form 5500 beyond the extended regulatory deadline, so now the plan is noncompliant with DOL reporting requirements. It's absolutely the worst I've seen as an auditor working with numerous service providers over 8+ years.

Their and their claims support (e.g. explanation of benefits and how out of pocket was determined) lacks in clarity in comparison to other claims administrators.

Meritain a subsidiary of Aetnaallows its members to see Aetna providers.

But, on the other end of this, they have paid me perhaps 10% of bills submitted.

Calling them for assistance goes like this:

Me: Hi still you havent paid me, why?

Them: (long convoluted reasons)

Me: can you tell me what steps to take to be paid for my services?

Them: (nonsensical phrases that involve no actionable plan)

Me: I need to speak w a supervisor

Them: (puts me on hold 3 times. Total call time 40min) no one is available, theyll call you later.

Me: what is your supervisors name?

Them: I dont know

Me: youre telling that you dont know the name of your supervisor?

It goes on like this for awhile.

My company switched to Aetna Meritain last year. This review is for the RSV vaccine, which can only be reimbursed by Aetna Meritain if given by a medical provider, mine does not give it.

Cannot get it at a pharmacy. I spoke numerous times with Aetna Meritain staff. They suggested CVS minute clinics; however, CVS minute clinics have never had it in my area. They suggested a particular doctor; I called a few times; they have never given and do not give this vaccine.

I called Urgent Care which does not provide it. I suppose they prefer that someone get really sick and then they will have to pay a lot more than the $300 that it costs.