Meritain Health

I would like to take a moment to share my experience with Meritain Health over the past year. Unfortunately, it has been a challenging and frustrating journey.

In June, my physician submitted a request for approval for a necessary surgery. However, the request was denied due to unclear guidance on the correct submission process. It wasnt until later that we learned the paperwork needed to be submitted through a specific portal. Had this information been provided upfront, we could have avoided unnecessary delays.

The paperwork was resubmitted through the proper channels, only to be denied again due to missing documents.

Instead of keeping the case open to allow my physician time to provide the additional paperwork, the case was closed, requiring a third submission. Even after the missing document was sent, Meritain Health claimed they never received it. The paperwork was sent again, only to receive the same response: they hadnt received it. My case was closed yet again.

Now, in December, I am still stuck in a loop of resubmissions, with no resolution in sight.

From a patients perspective, its incredibly disheartening to spend six months navigating this back-and-forth between my physician and Meritain Health. The lack of communication and consideration for the patients well-being is deeply concerning. I have been waiting for a medical procedure that is crucial to my health, yet the process is stalled by clerical inefficiencies.

Adding to the frustration, Meritain Health refuses to communicate directly with me, the patient. Instead, I am forced to rely on a third party to obtain any updates or clarification, turning the entire process into a frustrating game of ping-pong between the patient, the physician, and the insurer.

Where is the patient in this process?

Why is patient care not prioritized? Meritain Health needs to reevaluate its approach to patient care.

There must be a more efficient process that prioritizes the health and well-being of patients over bureaucratic red tape. The current system is neither effective nor patient-centered, and it leaves those in need of care feeling unheard and neglected.

I sincerely hope Meritain Health takes this feedback seriously and makes the necessary improvements to ensure patients are treated with the respect and urgency they deserve.

I started the process in August 2024 for DME supplies needed for my daughter. In September, Meritain told me paperwork was missing from the provider.

I contacted the provider and the necessary paperwork was submitted. In October, I contacted Meritain again and they said the paperwork was being reviewed. On October 22, Meritain could not find the paperwork for a single case agreement. After being put on hold, they finally found it, but it was in the wrong place.

They said it would be 3-5 days for an answer. Meanwhile, I ordered supplies out of pocket. I contacted Meritain again on November 7, and they could not find the paperwork again, but ultimately did. It was filed in the wrong place again.

The situation is now escalated.

I guess I will call them every day!

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.