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4.5

I moved to the USA in 03/16 and waiting until I got a job before applying for health insurance (I wanted to see if the job would pay or not). It didn't. So I went through Marketplace to Molina.

Marketplace set my start date to 5/1/16, but I told them I am a Diabetic I don't have enough medication to last me until 5/1/16 so I need it starting asap. I had an appointment with Nurse on 4/25/16 had blood tests done and was given a prescription. Went to walmart who told me it would be $470 so I said wait for 5 days.

I got a bill from Doctor's office for $238 so I paid it.

Marketplace escalated a grievance and on 5/30/16 agreed to retroactive start my insurance to 4/1/16. I submitted a grievance to Molina for $238 to recoup the money I paid.

Then 6/30 I got a statement from Doctors for $110 (for the 4/25/16 date of service. I submitted it to Molina, they rejected it stating my start date was 5/1. But they approved the $238 but it would take 30 business days to process. 6/30 I confirm they have accepted the grievance and would send it to payment processing and another 30 days. I was told 8/1 that my start date had been changed to 4/1 following a conference call between Molina and Marketplace that I should resubmit the $110. It was rejected again. And my start date changed back to 5/1 on Molina's system.

7/30 they confirmed payment should reach Doctors for $238 by 8/13.

8/13 I called Molina checking on the payments for both claims and was told both cases had been rejected as my start date is 5/1 not 4/1.

Having read through all my notes they escilated to team leader and escilated it to Review team, they now have 72 hours so until 8/24 to confirm everything is resolved, $348 is paid to the Doctors and I get my $238 back.

There seems to be some issue with their computer system, when the administrators make a change on my account, it resets back to the incorrect information. Its now 4 months of dealing with this. ***.

Reason of review: Problems with payment.

Monetary Loss: $238.

Preferred solution: Deliver product or service ordered.

Molina Healthcare Pros: Customer service.

Molina Healthcare Cons: Administrative processing.

Location: Racine, Wisconsin

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