Need Help: Health Plans, Inc Admits Issue on Account, Provides No ETA on Resolution.

hello,

Hope this is an alright forum for this, I'm not sure where to look for answers right now. I have Health Plans, Inc insurance through my employer. I'm in MA, USA, if that is relevant. I've been paying for my insurance through my paychecks as normal. I'm on a HDHP with a 3200 deductible (individual plan). My plan pays zero benefits until the deductible is met, but I had minor surgery this year, monthly prescriber appointments, and bi-weekly therapy that all hit this insurance. The other day it occurred to me I was still paying full price for everything, and I checked the site. It said I had paid $6,384.31 towards my deductible and was -$3,384.31 from meeting it. I was a little dumbfounded, so I looked at a few EOBs to see what was there. They show that my insurance negotiated cost, but paid nothing. Obviously I realized something was wrong and called in. The woman I spoke to was kind, understanding, and immediately escalated my issue to IT. She reached out Monday to let me know they were still working on it, and I responded this morning to ask if there was an ETA. The response I got a few minutes ago, verbatim:

"Hi (my name),

Our leadership has identified this is a known issue that is trying to get worked out with Health Plans, inc. for our members They have not yet provided an update on when it will be resolved, but I will definitely keep you updated.

Best, (agent I spoke with on the phone)."

This response sounds to me a little bit like this is a bigger issue than just me, and that they may not even be paying benefits at all for multiple members. I estimated that I should have received at least a few thousand in benefits so far, and they've paid literally nothing this whole year.

What are my options here? It's not open enrollment, so I can't switch plans. I can't withhold payment as it's taken out of my check. I can't sue for services not rendered (I don't think?). But also – it really sounds like this isn't just me based on the response. Has anyone else had this issue? This feels wildly illegal, but I don't feel like I have any recourse.

Any advice would be really appreciated! Thank you.

submitted by /u/yarnitza
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