Complaints

• Initial Complaint

  02/29/2024

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I’ve been trying with proactive insurance since last year and I’m not getting anywhere with these people. My Doctor prescribed me some medication for my health and you have to be half near dead for this medication to be approved. I’m sick of going through this with this company. My A1C has to be a 6.5 or greater for the prescription to keep me from being Diabetic, they keep rejecting it due to those reason. I’m very sick. This is by far the worst experience ever. The customer service rep Taylor.W isn’t helpful. He’s rude and nasty. Don’t know how to talk to anyone. Refuse to let me speak to a manager after requesting one several times! I’ve never had to experience anything like this.

  Business response

  03/06/2024

  Proact sincerely apologies for any inconvenience or frustrations this situation may have caused you. We have reviewed your concerns and the details of the data surrounding the medications you were attempting to process and the call that was mentioned from February 29th. We have reviewed the prior authorization history for the medications in question and below are our findings. The prescriber had attempted to request four different medications relating to your health needs. Unfortunately, all the medications that were requested by the provider were reviewed and denied by the clinical department. These were denied due to the lab documentation not meeting the established medication-specific criteria, as well as, FDA recommendations/ guidelines or the medication was listed as a plan exclusion according to your plan benefit. The prescriber did appeal one of the medication denials for an off-label diagnosis. However, this was still denied due to the following: “The Food and Drug Administration (FDA) has not approved this medication for use in treating your patient’s condition and the clinical information submitted by your office does not meet the criteria established for Off-Label Drug use, in accordance with the terms and conditions of the members plan benefit.” It was also notated that lab documentation still needed to be provided to support the criteria required. The phone conversation that was mentioned in the complaint from February 29th was pulled and assessed. On the phone call, the member was attempting to obtain information on the processing of her medications, the prior authorizations needed, and clarification for the denials. Our representative explained the clinical notes to the member on the denials and that the criteria was not met based on the FDA standards and plan benefit. The member requested to speak to a manager or Supervisor. It was stated that there was not one available at this time, and that a call back could be set up. The member did not approve of that answer and requested to speak to someone immediately. There was a long pause where neither party spoke, while the customer service representative attempted to locate a supervisor. After several minutes, he was able to connect with a supervisor and the call was transferred. We again apologize for any inconvenience and the representative’s demeanor on the phone call from the 29th. We hope that we will have the opportunity to regain your confidence in ProAct. We are 100% committed to providing the best customer service possible. If you wish to discuss this further, please reach out to our help desk at ###-###-####.

• Initial Complaint

  08/01/2023

  Complaint Type:

  Billing Issues

  Status:

  Resolved

  More info

  For the last five years I have repeatedly experienced difficulty with this company with regard to my son’s prescription medication, which is a non-preferred brand name medication. This company is unaware of their own procedures and policies for approving our access to this medication. They do not know how to process the letter of medical necessity for this medication which allows us to purchase the drug at a reasonable price. My son has now gone several months without his medication because they cannot (or will not) review the letter submitted by the physician and apply the necessity to my sons account. As a result, medication that would cost $4 per month (with a manufacturer coupon applied), costs $389 for a one-month supply. There is one person, Liz, who works there who has ever known how to assist us, but she has been promoted and I have been unsuccessful in getting my issue resolved. I cannot get any senior representatives to call me back and no employees who answer the phone can figure out how to solve this problem. I feel as though I am teaching them. My child is being denied access to necessary medication due to the incompetence of this organization.

  Business response

  08/07/2023

  Our standard process here at ProAct surrounding brand name medications and potential DAW penalties includes the ability to submit a request through the prior authorization process to identify a brand name medication medically necessary. If found appropriate, the DAW penalty will be waived through this process. For this particular member, the standard process was initiated in May 2022 where the member was approved the brand medication as medically necessary which waived the penalty. This authorization expired on May 19, 2023. With no standard prior authorization edit associated with requested brand per the member’s plan benefit, the claim that was processed after the authorization expired paid through at the higher copay. At this time, we have initiated a new prior authorization request and are working with the provider to update the medically necessary need and will place the authorization once appropriate documentation is received.

  We truly understand the frustration and empathize with you on any inconvenience this may have caused. We hope to have the opportunity to regain your confidence in future interaction with ProAct. We are 100% committed in building a customer for life by providing the best customer service possible. If you have any further questions or concerns, please do not hesitate to contact us at **************. Our customer service representatives are available 24 hours a day, 7 days a week. 

  Customer response

  08/07/2023

  Better Business Bureau:
  I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  Regards,
  ******* ***
  
  
  
  
  

• Initial Complaint

  06/07/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I obtained health coverage by ***** ****** Network via their *********** plan upon losing my COBRA coverage from my previous employer. Through this coverage I was forced to use ProAct. I paid for full coverage to take effect on May 1st on April 24th and discovered on May 10th that ProAct did not have me as an active member. I called my main insurance the following day (May 11th) to get further clarity and they alerted me that my information had never been shared with ProAct which was why I was not yet active, even though I should have been receiving full coverage. I was told that my information would be passed along to ProAct and that everything should be taken care of. I reached out to the insurance company again on May 31st and was informed that it took them 6 days before they passed my information along, and that ProAct still did not have me in the system. So at this point, I had paid more than $300 to receive full insurance coverage for the month of May and only received partial coverage. The company receiving my payments will not issue a partial refund, even though I never received full coverage as paid for.

  Business response

  06/15/2023

  Although ProAct does administer the pharmacy benefits for Ms. ********* pharmacy benefit plan, we do require notification of eligibility from the third-party administrator. This notification was not received by ProAct until 6/4/2023 at which time the member became immediately eligible.  ProAct has reached out to the entity responsible to pass the eligibility file to make them aware of this complaint. Requests for refunds, plan changes and cancellations are to be referred to the enrollment firm. The phone number is found on the back of each ID card. For this member and their questions regarding their enrollment or the benefits the plan covers, contact ************ or ***************@************.com. If you have any questions regarding claims, contact ************ or visit members*******.com as this member may be eligible to submit a direct member reimbursement to be refunded the amount of her May 21st prescription that was paid out of pocket.  We truly understand the frustration and empathize with you on any inconvenience this may have caused.  We hope to have the opportunity to regain your confidence in future interaction with ProAct. We are 100% committed in building a customer for life by providing the best customer service possible. 

• Initial Complaint

  05/20/2022

  Complaint Type:

  Sales and Advertising Issues

  Status:

  Answered

  More info

  For months I've been ordering the same prescription medicine from this company and it always costs the same, $60. The last time my auto fill went through my payment was $115.11. I called this company to ask why it was so much more and they told me there is a "dispense as written" fee, meaning they charge more for the brand name medicine versus a generic. I was using the generic medicine for many years and still felt fatigue every day. My doctor switched me to the name brand to see if the fatigue would subside. It did subside, so we continued with the brand name medicine. Proact told me they could take the fee off if I had my doctor explain why I needed the brand name. I had my doctor send something over and proact denied my request. I called them again to ask what else I can do. I explained that it was also unfair to charge me nearly double the price without telling me. They didn't even give me the chance to work with my doctor to try to find a suitable substitute that wouldn't cause me fatigue again. It also wasn't advised that I switch my medicine again, so this seems like a dangerous thing to ask a patient to do over a fee. I spoke with proact many times and they refused to refund the fee. They also told me that now it's been too long to even try to get my doctor to appeal the denial. They said it had to be done in 30 days. I wasn't told this either. I had disputed the extra charge with my credit card company, so I was refunded the extra charge. However, proact just recently sent me a bill for the fee in the mail. This is the reason that it's now over the 30 days. I wasn't aware that they were still attempting to collect this fee from me. So once again, I was not given the chance to take care of the situation within their time frame. This feels like an impossible situation. I should have been told about the increase in price before I was charged. I should have been given an additional chance to dispute the fee with a doctor's request.

  Business response

  06/06/2022

  Proact Pharmacy Services sincerely apologies for any inconvenience or frustrations this situation may have caused you. We have reviewed your concerns and the details of the data surrounding the fill that was processed on March 22, 2022.
  

  We can confirm that in 2021 you were paying $60.00 for your brand medication. On November 8th 2021, an Account Manager from Proact, Inc. reached out to an office member at ******** ***** **** regarding the impending formulary changes that would go into effect on 1/1/2022.  Per ******** ***** ****’s direction, letters for formulary changes are not sent from Proact. With the change from the Select formulary to the Core formulary, this medication changed from a Tier 2 drug to a Non-Preferred Tier 3 drug. This means that the member is charged a DAW penalty for non-preferred brand medication.
  

  When Proact Pharmacy Services processed your prescription request for the non-preferred brand medication on March 22nd, it was adjudicated per Standard Operating Procedure.  The copay of $115.11 did not meet our high copay threshold of $130.00, per our SOP.  If it had, our team would have performed an outbound call to the member for notification and approval.
  

  On March 25th, you placed a call to our Help Desk questioning the copay difference and was given the explanation of the DAW penalty from both the Customer Service Representative and a Senior Call Center Representative. At the time of this phone call, it was communicated that the DAW penalty fee would not be waived. However, it was advised that the prescribing office could submit a Prior Authorization to our Clinical Department. If the Prior Authorization met the criteria to be approved, the penalty could potentially be waived.  No guarantees were provided.
  

  Also on March 25th, the Clinical Department received the prior authorization request from your prescribing office and the documentation was reviewed. On March 29th, this request was denied coverage for the following reasoning:
              “The clinical notes do not support the following criteria: Trail and failure, contraindication, or intolerance” to A/B rated generic. 
  

  A letter of denial was also sent to both the prescribing office and you outlining the reason for the denial and the steps that can be taken to appeal the decision. As stated on the letter, the deadline for this appeal is 180 days from the date of the original denial on the claim. At this time, there has not been an appeal made for this decision. This appeal will need to contain data on the outcome of when and how long the generic medication was tried.
  

  On April 8th, Proact Pharmacy Services received notification that $55.11 was being disputed from the Credit Card that we utilized to process the copayment of the prescription. With documentation from the previous representatives, that was communicated to you in March, that fee would not be waived. Proact Pharmacy Services requested that a house account be made for the $55.11 and charged for the disputed amount via bill in the mail.
  

  If Proact receives proper notification and criteria of the appeal are met by September 25, 2022, the DAW penalty fee could potentially be waived for the past fill that was processed and future fills that are within the approved time frame for the Prior Authorization.
  

  We truly understand your frustration and empathize with you on any inconvenience this may have caused.  We hope to have the opportunity to regain your confidence in future interaction with ProAct. We are 100% committed in building a customer for life by providing the best customer service possible. If you wish to discuss this further, please reach out to our help desk at ###-###-####.

  Customer response

  06/11/2022

  Better Business Bureau: I have reviewed the response made by the business in reference to complaint ID ********, and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below. This company is making me jump through hoops to get a fair price for a medication I need to take on a daily basis for my health. I should not be forced to go to such lengths to take care of my body. It’s a shame that this company is basically trying to scam their customers.  I would only be satisfied if the initial fee was waived. I could then be given the chance to talk to my doctor about a different generic brand to try since the generic brand I had been taking for about 9 years had never worked for my fatigue and only taking the brand named medication alleviated it. My doctor is only available some months out so asking to see them immediately was impossible.  Regards, ******* *******

*Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business. ↩