ComplaintsforWEX Health, Inc.
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Complaint Details
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Initial Complaint
10/18/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
My son, ******** *******, was born ******. We submitted this information and the necessary documentation to WEX by email on July 31. I called Aug 21 to check on the status, at which point they said he was added that day and mailed me documentation. However, despite many phone calls to both WEX and ****, he is still not showing on our coverage. **** says they have not received the necessary information from ***. Each time I call WEX, they say something has been done, and now I need to wait x number of business days for it to be processed, so I am in this endless loop of call and try, and wait to find out nothing has changed.I have outstanding bills that should be covered by insurance that need to be be paid. It has been 2.5 months waiting to get one standard task done.Business response
10/31/2024
WEX Health appreciates the opportunity to respond to this participants complaint. It is our goal to provide high quality customer service while at the same time ensuring plan compliance.
*** is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with employers. *** is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers. Once we send notification to the carrier, it is the carrier's responsibility to update its records. All premiums received by *** are remitted monthly and are not retained by WEX.
WEX received an Addition of a Dependent form from the participant on July 31, 2024, requesting to add coverage for their dependent effective July 3, 2024. To process this request, *** contacted the participants former employer to confirm the carrier's plan rules as they apply to the effective date for adding dependents. Once confirmed, *** added the participants dependent to coverage on August 20, 2024, backdated to July ******, and notified the insurance carriers to add the dependent on August *******, using the contact information provided by the participants former employer.
On September 13, 2024, *** received the participants call regarding the status of their coverage. In an effort to assist, *** sent an urgent update request to the carrier on September 19, 2024.
On October 23, 2024, *** contacted the carrier again to confirm the participants coverage status. In response, the carrier requested additional information, which *** provided. As of October 29, 2024, WEX received confirmation from the carrier that the dependents coverage is in effect as of July 3, 2024, with no gap in coverage. The participant or their providers may resubmit any claims incurred from the date that coverage was in effect to the insurance carrier for their review.
The participant may contact our ******************** team with any questions.Initial Complaint
10/14/2024
- Complaint Type:
- Order Issues
- Status:
- Answered
My *** provider through my employer has failed to get my card to my address and an alternate address provided in order to pay for medical/dental expenses for my family. Despite the ************** I've provided from medical professionals they deny the claims and refuse to reimburse money I've paid out of pocket. Supervisors allegedly can't do anything nor contact me to discuss why they're stealing my money.Customer response
10/27/2024
I have not heard from the business in response to my complaint.Business response
10/30/2024
WEX Health appreciates the opportunity to respond to this participants complaint.*** places the utmost importance on customer service. It is our goal to provide high quality customer service while at the same time ensuring plan compliance. We understand that the various regulatory requirements can be confusing and are often frustrating to participants and their family members. We do our best to try to simplify and streamline the process to make it easier.
Per enrollment information provided to WEX by the participants employer, this participant is enrolled in a health flexible spending account *********************** FSA). Enrollment records do not show this participant is enrolled in a Health Savings Account (HSA).
The plan in which this participant is enrolled is an employer-sponsored plan governed by *** regulations and plan rules as defined in the employers plan document and summary plan description. *** provides administrative services on behalf of employers pursuant to service contracts with the employer.
*** rules governing flexible spending accounts require that all claims be substantiated, even those paid using a debit card. *** rules require that the documentation used to substantiate claims include the provider or merchant name, date the service was incurred, type of service, cost of the service, and,when there is insurance, amount insurance has paid. An Explanation of Benefits (EOB) from the insurance carrier usually provides this required information.
Of the 6 claims submitted during the plan year, 1 claim was approved as documentation meeting *** requirements was provided by the participant. 1 claim was denied as the substantiation submitted indicates that it was a treatment plan. As the documentation did not contain the date the service was incurred,the actual cost of the service, and the amount, if any, paid by insurance. 1 claim denied as fuel is not eligible for reimbursement through a health FSA. 2 additional claims remain denied as substantiation meeting *** requirements has not been submitted.
WEX mailed a replacement debit card to the participant on October 25, 2024 to the address listed on his account.
The participant can contact the ************************ team with questions or for further information.Customer response
11/05/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
FAQ
Regards,Mark
Initial Complaint
10/08/2024
- Complaint Type:
- Order Issues
- Status:
- Resolved
My COBRA Dental Payments are NOT posting to my **************** since 8/5/24:WEXHealth (COBRA provider at **************) has sent numerous notices to ************* regarding the payments, however since 8/5/2024 the dental payments for employer ******************************** (PDENT- Dental) are still showing unpaid and the dental insurance inactive for ID: ************. I have called customer service at ************** and **** membership services at ************** multiple times on the following dates:8/29/2024 9/3/2024 9/30/2024 10/3/2024 10/7/2024 10/8/2024 Each time I am told to wait 3 business days. I wait and still my policy is unpaid. However the payments have been posted on the WEX health side. ********** and Blue Shield will not discuss the payment error since WEX is payer and needs to correct the issue. However each time I call no action has resulted and my DENTAL policy remains inactive.Payments Processed:8/5/2024 $1181.40 = (****** x 2)9/12/2024 $1772.10 =(****** x3)Each payment posted for $****** = $570.24 (medical) and $20.46(dental). However none of the dental payments are being posted correctly.Customer response
10/19/2024
[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Better Business Bureau:
I have reviewed the response submitted by the business and have determined that the response does satisfy my issues and/or concerns in reference to complaint #22398025. I understand that by choosing to accept the business response that my complaint will be closed as resolved.
Regards,
Scott RoybalInitial Complaint
09/23/2024
- Complaint Type:
- Sales and Advertising Issues
- Status:
- Answered
09/01/2022 purchased ongoing *************** because my son had aged out of our insurance this info was sent through the city and I paid reoccurring payments monthly, used the insurance rarely went to the dentist and they can find no coverage. Spent hours on the phone with WEX saying I am covered. Called Delta said not covered since 9/23. Been paying premiums monthly. No customer service is able to help whenever I call and *** blames ************ Delta dental has no idea what they can do since i am not a subscriber according to themBusiness response
10/21/2024
WEX Health appreciates the opportunity to respond to this participants complaint. It is our goal to provide high quality customer service while at the same time ensuring plan compliance.
*** is a third party administrator that provides ***** administrative services on behalf of employers pursuant to service contracts with employers. *** is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers. Once we send notification to the carrier, it is the carrier's responsibility to update its records. All premiums received by *** are remitted monthly and are not retained by WEX.
WEX processed the participants online ***** election on September 13, 2022 and received the participants full initial payment on September 21, 2022. Consistent with *****, upon receiving payment WEX notified the insurance carriers of the participants elections on September 22, 2022 using the contact information for the carriers provided by the participants former employer.
WEX processed annual plan and rate changes effective April 1, 2023 on behalf of the participants former employer, which included a change in the insurance carrier for the dental plan. *** notified the new insurance carrier of the participants ***** enrollment on March 2, 2023 using the contact information provided by the participants former employer.
On September 23, 2024, *** received the participants call regarding the status of their coverage. In an effort to assist, *** sent an urgent update request to the carrier the same day.
WEX also processed the participants online request to terminate their ***** coverage effective September 30, 2024.
WEX contacted the participants former employer to request their assistance in working with the insurance carrier to confirm that the participants coverage was in effect. As of October 18, 2024, *** received confirmation from the participants former employer that their dental coverage is in effect from April 1, 2023 through September 30, 2024. The participant or the providers may resubmit any claims incurred from the date that coverage was in effect to the insurance carrier for their review.
WEX is unable to accommodate the participants request for a refund of the ***** premium. The participants ***** coverage was in effect during the period requested and the premiums have been forwarded to the carrier.
The participant may contact our ******************** team with any questions.Initial Complaint
09/11/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
I claimed my annual eye exam and prescription glasses from my insurance(ID#**********, GeoBlue, on July 5th.The claim number is 14654029.Under my insurance policy, I can enjoy full coverage of eye examination and 250 USD for prescription glasses annually.The eye exam fee is 59USD and the prescription glasses fee is ******USD. I did both of them in the ********** so the gave me one invoice with description. But the ******* just approved 250USD. When I called the customer services on July 11th, either the service or their supervisor just insist that they gave me correct and didn't review or check my insurance policy. They tried to convince me the maximum is only 250USD with their revised document and focused the glasses, but neglect the eye exam fee, 59USD. After that I emailed an appeal form(Case Number: ********) to them and haven't received the reply until September 11th, which their system said it would be reviewed and notify within 30 days.Business response
09/17/2024
WEX Health is unable to identify this individual with the mailing address,telephone number, and e-mail address provided through the Better Business Bureau complaint. As such, we are unable to respond to the individuals complaint.
If the individual would like to provide additional identifying information, WEX would be happy to further review.Initial Complaint
09/01/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
I am an employee at ***** Health. My employer has contracted through *** as its provider to manage our Flexible Spending Account (FSA). We are provided a debit card to use at time of transaction to pay for medical expenses. Other than my prescriptions, *** has denied EVERY other claim I have made without exception. They require a receipt which needs to include 3 criteria: 1) date of service 2) Provider 3) Services Rendered. I have attached 2 examples of denial letters and one example of a receipt which I provided. In that particular example I submitted the receipt 3x! Finally on the 3rd submission, I highlighted each required component. Eventually that was resolved, but soon had other denials. In fact my card is now locked out until bill is resolved, despite submitting receipts. We shouldn't have to submit receipts more than once. It has been very time consuming dealing with this company to get the money back which I have specifically allotted to health care costs (FSA). I would not be surprised if you have received other similar complaints.Business response
09/10/2024
WEX Health, Inc. appreciates the opportunity to respond to this participants complaint. *** places the utmost importance on customer service. It is our goal to provide high quality customer service while at the same time ensuring plan compliance. We understand that the various regulatory requirements can be confusing and are often frustrating to participants and their family members. We do our best to try to simplify and streamline the process to make it easier.
The plan in which this participant is enrolled is an employer-sponsored plan governed by *** regulations and plan rules as defined in the employers plan document and summary plan description. *** provides administrative services on behalf of employers pursuant to service contracts with the employer.
*** rules govern substantiation requirements for the health FSA, including expenses paid using the debit card. Per *** regulations, medical expenses are incurred when the employee (or the employee's spouse or dependents) is provided with the medical care that gives rise to the medical expenses, and not when the employee is formally billed, charged for, or pays for the medical care.
The *** requires that the documentation include the provider or merchant name, the date the service was incurred, the type of service, the cost of the service, and, when there is insurance, the amount insurance has paid. A receipt alone generally does not meet *** requirements. An Explanation of Benefits (EOB) from the insurance carrier would provide this required information.
*** regulations outline correction procedures that must be followed if a debit card transaction is not properly substantiated. The first step is to deactivate the debit card until documentation is received, the amount is repaid to the account, or the expense is offset with another eligible expense not paid using the debit card. When the debit card is suspended, a participant maintains access to funds in the account. Requests for reimbursement may be made by filing an online claim through the member portal, submitting an expense via the mobile app, or using an Out of Pocket Reimbursement Request Form.
This participant has 12 claims for the health flexible spending account *********************** FSA) 2024 plan year. All 12 were debit card transactions. Of the 12 claims, 8 were auto approved through copay match or **** approval that did not require substantiation under *** rules. Four debit card claims require documentation. The receipts initially submitted by the participant for 2 of these claims did not include the date of service or type of service. The participant subsequently provided sufficient documentation to approve one of the denied claims. The substantiation provided by the participant with this complaint was sufficient to approve one of the previously denied claims. This document was not previously submitted to WEX.
Two claims remain denied as no substantiation has been provided.
Even though debit card transactions may be denied due to lack of or insufficient documentation, the merchant remains paid. In addition, any funds that may remain in a participants account after the end of the plan year are forfeited to the plan and are not retained by WEX.
The participant can contact the ************************ team for further information on claim substantiation.Customer response
09/12/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]
Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.
FAQ
Regards,Andreas
I acknowledge the rules associated with my flexible spending account. However, i contend that I indeed met my obligation, sending the receipt for $11.62 3 separate times. I included the receipt that I sent for $254.97. Wouldn't you agree that I met the criteria they outlined in their response? Meanwhile my card is frozen and I can not even use it to cover $5 prescriptions. The amount of hoops this company makes us employees jump is beyond ridiculous. There has to be a better way. In my mind it is fraudulent to repeatedly deny claims that were correctly submitted.
Business response
09/20/2024
WEX Health appreciates the opportunity to respond to this participants complaint.*** places the utmost importance on customer service. It is our goal to provide high quality customer service while at the same time ensuring plan compliance. We understand that the various regulatory requirements can be confusing and are often frustrating to participants and their family members. We do our best to try to simplify and streamline the process to make it easier.
The plan in which this participant was enrolled is an employer-sponsored plan governed by *** regulations and plan rules as defined in the employers plan document and summary plan description. *** provides administrative services on behalf of employers pursuant to service contracts with the employer.
As stated in our previous response, the substantiation provided by the participant with his initial complaint was sufficient to approve the previously denied claim in the amount of $11.62. *** conducted a thorough review of the participants accounts and WEXs records, and this document was not previously submitted to WEX.
*** regulations outline correction procedures that must be followed if a debit card transaction is not properly substantiated. The first step is to deactivate the debit card until documentation is received, the amount is repaid to the account, or the expense is offset with another eligible expense not paid using the debit card. When the debit card is suspended, a participant maintains access to funds in the account. Requests for reimbursement may be made by filing an online claim through the member portal, submitting an expense via the mobile app, or using an Out of Pocket Reimbursement Request Form.
As the participant has remaining debit card transactions that have not been substantiated in accordance with *** regulations, his debit card must remain suspended.
Even though debit card transactions may be denied due to lack of or insufficient documentation, the merchant remains paid. In addition, any funds that may remain in a participants account after the end of the plan year are forfeited to the plan and are not retained by WEX.
The participant can contact the ************************ team for further information on claim substantiation.Initial Complaint
08/26/2024
- Complaint Type:
- Sales and Advertising Issues
- Status:
- Answered
From January to June 2024 approximately $2500+ was taken from my salary for my dependent care. In June I retired, which according to Wex, meant I lost all monies paid to them. I was never notified that I needed to submit anything before my retirement date. My access was turned off and I was not able to submit for dependent care reimbursement because according to Wex, "you should have read the fine print". Of course nothing was ever sent saying I had a balance and needed to submit receipts by a particular date because this is how this company makes money scamming its customers.Business response
09/10/2024
WEX Health appreciates the opportunity to respond to this participants complaint. *** places the utmost importance on customer service. It is our goal to provide high quality customer service while at the same time ensuring plan compliance.
The plans in which this participant was enrolled are employer-sponsored plans governed by *** regulations and plan rules as defined in the employers plan document and summary plan description. WEX Health provides administrative services on behalf of employers pursuant to service contracts with the employer.
Under the terms of the employers plan, terminated employees may submit requests for reimbursement of expenses incurred prior to the last day of employment up to 30 days following the termination of employment. This information is included in the summary plan description (SPD) provided by the employer to each participant upon enrollment into the plan.
According to the employers plan design, the final date to incur expenses (final service date) was June 4, 2024. The final date to submit eligible expenses (final filing date) was July 5, 2024. As the final filing date for this plan has passed, WEX is no longer able to accept requests for the dependent care flexible spending account (dependent care FSA) 2024 plan year.
In accordance with *** rules, any funds that may remain in a participants account after the end of the plan year are forfeited to the employer-sponsored plan and are not retained by WEX.
The participant can contact the ************************ team with questions or for further information.Initial Complaint
08/20/2024
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I have 650$ in a flexible spending account for preventative medical appointments and dental . I have sent in reimbursement forms with receipts. *** has not filed the claim for over a month and now is denying it. **************** tells me wrong or different information each time I call with no help . Ive sent them receipts with dates of past appointments and I would like my reimbursement.Business response
09/05/2024
WEX Health, Inc. appreciates the opportunity to respond to this participants complaint. *** places the utmost importance on customer service. It is our goal to provide high quality customer service while at the same time ensuring plan compliance. We understand that the various regulatory requirements can be confusing and are often frustrating to participants and their family members. We do our best to try to simplify and streamline the process to make it easier.
The plans in which this participant is enrolled are employer-sponsored plans governed by *** regulations and plan rules as defined in the employers plan documents and summary plan descriptions. *** provides administrative services on behalf of employers pursuant to service contracts with the employer.
This participant is enrolled in both a limited purpose health flexible spending account *********************** FSA) and a dependent care flexible spending account (dependent care FSA).
Per *** regulations, only services incurred while a participant is active in the plan may be reimbursed. The participant submitted limited purpose *** claims for reimbursement. As the dates of service for these claims were all prior to the participants enrollment in the plan,they are not eligible for reimbursement.
Of the 4 dependent care *** claims submitted by the participant, 3 were approved. One claim remains denied as the expenses were incurred during the participants leave of absence. Under IRS rules, eligible services that are reimbursable through a dependent care FSA must be for the purpose of enabling a participant to be gainfully employed.
WEX reviewed the participants communications with the ************************ team. Unfortunately, her experience was not a smooth one and for that, we apologize.
The participant may contact the ************************ team with any questions.Initial Complaint
08/15/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
I lost my job in March this year. I signed up for Cobra extension. I had set up automatic payments and I received no communication from them about premiums due. They canceled my policy and I received no warning until after my policy was canceled. I didn't realize it until my health care provider told me that my insurance was declined. I told them I am able to pay all of my premiums to get my account current and they refuse to saying that they have to adhere to the ***** periods put in place. I tried to call them 6 times to resolve the issue and when you press 0 to speak to a person, the line disconnects every time. My question is, if I didn't receive notice that my payment was delinquent, how would I know this? I lost my job and I just want to continue my health insurance. They are supposed to help people, not hurt people. The attachment shows the only communication received from them. After my confirmation of enrollment, I received nothing until my policy was terminated, at which point they are telling me that there is nothing I can do at that point. Again, I set up autopay, but there was a mishap somehow.Business response
08/26/2024
WEX Health appreciates the opportunity to respond to this participants complaint. It is our goal to provide high quality customer service while at the same time ensuring plan compliance.
WEX is a third party administrator that provides COBRA administrative services on behalf of employers pursuant to service contracts with employers. WEX is not an insurance carrier and does not have access to or control of the records or processes of insurance carriers.
WEX was notified of the participants qualifying event on March 24, 2024 and mailed to them a COBRA Specific Rights Notice on March 25, 2024. This Notice included information on plans, election and payment deadlines, and instructions for electing COBRA and making the initial and subsequent monthly payments. This Notice also explained the consequences of failing to make timely premium payments. This Notice listed the phone number to contact the ************************ team *************).
WEX processed the participants online COBRA election and received authorization for two, one-time online payments on May 16, 2024. WEX mailed to the participant an Enrollment Confirmation Notice on May 17, 2024.This Notice confirmed the receipt of the participants election, included a payment schedule and payment coupons indicating the premium due dates and the total amount owed each month, and explained the consequences for failing to make timely premium payments. This Notice also listed the phone number to contact the ************************ team *************).
Although WEX processed the participants online COBRA election and received authorization for two, one-time online payments, WEX does not have record of the participant attempting to enroll in the recurring ACH payment method.
WEX did not receive the participants June 2024 premium within the grace ****** allowed and their COBRA coverage was terminated effective May 31, 2024 and cannot be reinstated. On June 7, 2024, WEX mailed a COBRA Termination Notice to the participant.
WEX received emails from the participant on August 14 and August 15, 2024 regarding the status of their coverage. A WEX team member advised that the participants COBRA coverage terminated effective May 31, 2024 due to non-payment of premium.
WEX conducted a thorough review and located calls from the participant on August 14, 2024. However, the calls were placed to a temporary phone number intended for questions related to the **** disaster relief during the ***** National Emergency. This phone number was not listed in any correspondence sent to the participant.
COBRA regulations and the Department of Labor do not require that monthly payment reminders or advance notice of termination of COBRA coverage be provided to qualified beneficiaries. WEX provides payment coupons and it is the responsibility of the qualified beneficiary to ensure timely premium payments are made.
The participant may contact our ******************** team with any questions.Initial Complaint
08/09/2024
- Complaint Type:
- Billing Issues
- Status:
- Answered
It is said by their system that I currently have an available balance. I spoke with an employee at their office today 8/8/2024 who stated that even though I was told that the funds would remain available until one year from separation the date was adjusted instead. The employee confirmed my conversation with the previous employee when I called to close the account and be issued the funds. I ask that the company refund to me the remaining balance that their system confirms is still available as of 8/8/2024.Customer response
08/23/2024
I have not heard from the business in response to my complaint.Business response
08/30/2024
WEX Health appreciates the opportunity to respond to this participants complaint.*** places the utmost importance on customer service. It is our goal to provide high quality customer service while at the same time ensuring plan compliance.
The plan in which this participant was enrolled is an employer-sponsored plan governed by IRS regulations and plan rules as defined in the employers plan document and summary plan description. *** provides administrative services on behalf of employers pursuant to service contracts with the employer.
According to the terms of the participants former employers plan, participants who have terminated employment may submit requests within 90 days following the termination of employment for reimbursement of expenses incurred prior to the last day of employment. This information was included within the plan documentation provided to all eligible employees by the participants former employer.
The final date for this participant to incur expenses (final service date) was August 30, 2023, with the final date to submit eligible expenses (final filing date)as November 29, 2023. As the final filing date has passed, *** is no longer able to accept reimbursement requests from the participants 2023 health FSA.
*** was not notified by the participants former employer of the participants termination of employment until August 22, 2024. The participant contacted the ************************ team on November 6, 2023 with questions regarding his account balance. Due to the delay in the employment status update in the *** system, the ************************ team member initially provided the 2023 plan year final service date and final filing date for active employees rather than the final service date and final filing date that were applicable to the participants terminated status. Subsequently during that call, the ************************ team member did provide accurate information regarding the final filing date for terminated employees. *** sincerely apologizes for any confusion caused by the participants communication with the ******************** team.
IRS regulations forbid refunds of pre-tax contributions from FSAs and require eligible expenses to be submitted in accordance with the terms of the plan in order to be reimbursed. As the funds in a health care FSA are pre-tax, IRS rules prevent *** from distributing any funds without the submission of eligible expenses for reimbursement. In accordance with IRS rules, any funds that remains in a participants account after the end of the plan year are forfeited to the employer-sponsored plan and are not retained by ***.
The participant may contact the ************************ team for more information.
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Customer Complaints Summary
222 total complaints in the last 3 years.
92 complaints closed in the last 12 months.