Meritain Health

If I could give negative stars, I would. My sons had their wisdom teeth removed in May 2024.

The claims were submitted in June 2024. I had to call in September 2024 to find out why they hadn't been processed. I was told they hadn't been looked at yet by a human. Meritain has denied the claims and wants a letter of denial or an EOB stating the reason for denial before they process anything.

Our medical insurance classifies this as a dental claim, and even though I've submitted it numerous times, they see dental and automatically reject it. However, in this case, it's against their policy to provide any written documentation explaining the denial. Their own customer service rep was on the phone with our medical insurance rep, who clearly, verbally stated that this would never be covered under our medical plan. This is even in Meritain's notes!

But Meritain insists on a written denial they know we can't get. It's a bureaucratic loop designed to wear you down. I was told the claim was sent to adjusters on 6/21 and to wait 60 days. I finally called back today, only to find out it was denied on 6/22, one day later.

No call. No email. No notification. Just silence.

One kind rep said I could ask for her directly and she'd call me back. Turns out Meritain gives their reps 30 minutes a week to follow up with customers. That's not a typo. Thirty minutes.

A week. And when you do reach someone, half the time the connection is terrible, the rep is incomprehensible, or they sound like computerized. This isn't just poor service, it's deliberate obstruction. Meritain's system is built to frustrate, delay, and deny.

If you're considering them for coverage, run the other way.

Fast. I will forever tell anyone I speak to how horrible this company is.

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!