Complaints

• Initial Complaint

  10/25/2023

  Complaint Type:

  Billing Issues

  Status:

  Unanswered

  More info

  My son used an in-network therapist for several visits. His out of pocket should have been $0. We suddenly received an email from the therapist that ****** wasn't covering ANY of the claims for ANY of their ******-covered patients, and then a week later the therapist billed us for the full amount of $874.96. We contacted Accolade (the only number on the insurance card for ******* University of **********), and spoke with an "advocate" who said she would get the records needed and re-process the incorrectly denied claims. Since then, I have tried to contract the "advocate" at Accolade to find out the status of this. I have left her 5 messages over the past 3 weeks and she does not call me back. I have spoken to another representative at Accolade and he said he left her a message to contact me. I have received no contact and I don't know the status of all of this. This has been going on for several months now. I am almost ready to just pay the $874.96 bill to get this out of our lives. This is for my son, ******************.

• Initial Complaint

  07/12/2023

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I am writing this because I am getting very agitated with Accolade. I have contacted Accolade with questions about billing for be charged as Out of Network for Tricore reference labs (which I always use the same one) back on October 17, 2022. I never received an answer.Now on June 5, 2023, I have asked to find out if our insurance covers Gel injections for the arthritis in my knees. I have been instructed that I must collect all the information for them to be able to assist, such as CPT and DX codes. I completed a Accolade survey and was contacted about my concerns. Was told that I would get assigned a new member support person, since the one I have never answered any of my requests. Which then makes me start from the beginning again, again and again. They say they call attempt to contact me by phone, strange I have no calls listed on my phone at all. None of what I discuss about my survey was handled. I never receive a call or email from the new member support person either.I still have no answer about the gel shots. I know my doctor resent the per-approval request since I contacted them to provide one, which Accolade should have done. I have sent request through their messaging system - the last one (repeated since I did not not receive a reply as requested) as follows: As I have explained in the past numerous times, I work the night shift (midnight to 8:00mst), you may contact me by phone from the start of your hours 6:00am to around 11:00mst any day of the week including weekends. Ok, I am trying this again, maybe this time someone can finally provide me an answer. I am trying to find out if my plan covers gel shots for the arthritis in my knees. Do not ask me to contact my doctor, I have completed that and the new pre approval has been sent from them a couple of weeks ago. I just need the answer from the insurance company. I have reach out the insurance company which instructed to go back to Accolade for assistance. I have sent an email to my company also explaining the problems I am having in getting a response.I am hoping you could provide some assisting in getting them to response to any request.

  Business response

  07/31/2023

  July 27, 2023

  Dear *** *******:

  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.
  

  CONSUMER COMPLAINT: Complainant expressed that she wanted support regarding the denial of gel injections for arthritis in her knees and a claims issue from October 2022. Complainant alleges she did not receive responses from an Accolade Health Assistant in a timely manner.
  

  COMPLAINT RESPONSE: Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving our member experience.
  

  By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employees and dependent members of such employers’ group health plan (“member”) in better understanding their benefits, their personal costs and assisting them to better make efficient use of
  the healthcare system. In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for members.

  Although Accolade is able to support members in navigating their healthcare benefits, Accolade is not responsible for making claim determinations, coding of medical services, inspecting medical records or related documents, billing the provider or member, or influencing whether a health plan ultimately decides to extend coverage.
  

  Accolade was contacted by the Complainant regarding the denial of gel injections and unresolved claims issues from 2022. To resolve the denial of injections, the Health Assistant contacted the provider’s office leaving a message for a call back. Complainant has since reached out to Accolade on multiple occasions to follow up. To address her concerns, a Specialist reached out to Complainant to acknowledge the service breakdown, determine the procedure denial reasons, and research previous claims issues from 2022. Also, a new Health Assistant will be assigned to connect with the Complainant during her preferred schedule for future engagement and help ensure improved experiences with Accolade. Accordingly, Accolade requests that the complaint be resolved and closed.

  We greatly appreciate the feedback that we receive from our members, and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution and are happy to address any further questions.

  Regards,

  Director, Customer Support

  Customer response

  07/31/2023

  Acollade stated this resolved, it is not. I have no new assistance assigned to me. I have not been given any additional information about the gel shots by Acollade. My doctor did reach out to tell me the gel shot did not require pre-approval. But then Acollade contacted and said this was wrong that they had not talked to my doctor and gel shots are not covered. So now I am still waiting a answer again. 

  Customer response

  07/31/2023

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because:
  None of what Acollade stated they have done has been completed. I still have no answers to past charges being settled as out of network. And my doctor said they received word that gel shots require no pre-approval, but Acollade now says that they were never in touch with my doctor, so I could not be covered for the shots. So I have no answers to my questions at this time still.
  
  Regards,
  
  ***********************
  

  Business response

  08/15/2023

  August 14, 2023

  Dear *** *******:
  

  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.
  

  CONSUMER COMPLAINT: Complainant expressed that she wanted support regarding the denial of gel injections for arthritis in her knees and a claims issue from October 2022. Complainant alleges she did not receive responses from an Accolade Health Assistant in a timely manner.
  

  COMPLAINT RESPONSE:
  Accolade previously responded to the Complainant on July 27, 2023 and addressed the concern about the denial of gel injections and unresolved accumulator issues. The Accolade Representative (“AR”) assigned to the Complainants case made many attempts to connect with the provider to obtain the information needed to properly confirm this would be a covered service. The AR confirmed that these specific injections are considered investigational/experimental by the plan and are not covered. Our provider services team communicated this finding to the provider's office.
  

  We have also reached out to the Complainant to communicate this directly, providing a voicemail message with our findings along with encouragement to call and discuss other options. Additionally, we sent the update of non-coverage to her via our mobile messenger. There, we provided some additional options of self-paying for the services and additional resources of support and programs to address her underlying healthcare needs. We are still in the process of identifying the out of network accumulator and claims issues and would welcome the opportunity to continue to work with the Complainant and resolve to completion.
  

  While Accolade realizes that delays can be frustrating, our goal is to help avoid claim denials and misinformation provided, which take time to resolve. In this Complainants case, we were not able to obtain an answer from the providers office that made us confident that appropriate steps were taken on the providers end to confirm coverage. We acknowledge that there were initial miscommunications and  scheduling issues, to which we have provided coaching and customer service training to the AR, coupled with intervals and delays as we awaited a callback from the provider’s office to fully resolve.

  Accolade would like to express an apology, for our part, with delays presented within the overall coverage determination process. Accolade’s role is to support our members, including Complainant, in attempting to get resolution of their issues. Accordingly, Accolade requests that the complaint be resolved and closed.
  

  We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.
  

  Regards

  Director, Customer Support

  Customer response

  08/15/2023

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because: This response is not accurate at all. I reached October 13,2022 about out of network billing questions and never go t a response until Auguast9, 2023. And was informed that they are still figuring out my billing questions. As answering the questions about knee gel shots the final answer was received August 9, 2023 that they are not covered after 10 weeks of asking the same question. The problem with contacting someone is on their end. When you call you must start from scratch every time with a new person. I never received contact info from someone until August 9, 2023. When I talked to my doctor and his staff, they experienced the same contacting issues. There never was a problem of communication between me and my doctor and his staff, they kept me informed of their frustration with the inability to reach an Accolade representative that knew what was going on. 
  
  Regards,
  
  ***********************
  

• Initial Complaint

  07/06/2023

  Complaint Type:

  Customer Service Issues

  Status:

  Resolved

  More info

  Today, 7/6/2023 at 9:15am EST I had a call with ******* (Not sure of spelling- pronounced ********). This was a call back. ******, my employer recently switched us to **** and there are apparently issues with the switchover, which I was calling to get information on how to get care. Yesterday I was on hold for well over 1 hour and asked for a call back today, which is what this call was. When she called me back I let her know I have multiple issues that need resolved, but we never got past the first issue as she gave incorrect information, got snippy with me, refused to spell her name so I could find a way to identify her, and refused a supervisor. The first issue is that we, as ****** employees, are supposed to be able to use Doctor on Demand as a virtual option – my daughter and husband both have the exact same plan on I do as we are all employees of ******. My daughter sees a dr for Dr on Demand for a chronic issue that is very serious.. when trying to see someone on Dr on Demand it won’t take our new insurance. ******* gave me two options for this- either try ‘********’ or pay full price and Dr on Demand will pay back.. This is not how that works, which is what I told her. She said “I don’t know this is all between Dr on Demand and ****” which is just her pushing the issue off to other companies. She continued to argue with me about it, and I finally asked for a supervisor, which she refused, multiple times. She did the following during this call: • Called me “*****” (my daughter heard this) • Refused a supervisor multiple times • Refused to spell her name or give me any way to identify her for feedback • Laughed at me twice • Came back later in the call and offered to call Dr on Demand, but at this point I wanted someone other than her on the call • Cold transferred me back into the queue We never got to the other issue which is my deductible and max out of pocket have already been met but it’s not showing this on their system. I want this call listened to, and coaching done on this associate, as well as my issues resolved.

  Business response

  07/21/2023

  July 17, 2023

  Dear *** *******:
  

  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.
  CONSUMER COMPLAINT: Complainant expressed that she would like resolution to her inquiry regarding Doctor on Demand, that the initial interaction be reviewed by a Supervisor at Accolade and coaching provided to the Accolade Health Assistant.
  COMPLAINT RESPONSE: Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving our member experience.
  By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employee and dependent members of such employers’ group health plan (“member”) in better understanding their benefits, their personal costs and assisting them to better make efficient use of the healthcare system. In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for
  members. Although Accolade is able to support members in navigating their healthcare benefits, Accolade is not responsible for making claim determinations, coding of medical services, inspecting medical records or related documents, billing the provider or member, or influencing whether a health plan ultimately decides to extend coverage. 
  Accolade was contacted by the Complainant on 7/6/23 regarding Doctor on Demand not accepting the new **** ***** **** ****** Health Plan information when her daughter attempted to sign in for this service. The Complainant spoke with an Accolade Health Assistant who initially supported the member by guiding her to ******** or pay for the visit and receive reimbursement. The Complainant became escalated since she did not believe these were the correct solutions and asked to speak to a Supervisor.
  After a thorough review of the conversation, it is confirmed that although there was no specific referral to this member as ‘karen’, the overall engagement on the call was not in alignment with our expectations as it relates to the Health Assistant training and professionalism. To address this interaction, the Accolade Health Assistant will be provided coaching and continued customer service training to resolve future potential escalated issues. As of 7/17/23, the concerns mentioned by the Complainant have been noted and brought to the Supervisor for coaching.
  Accolade’s role is to support its members in attempting to get resolution of their issues. After the Complainant was transferred, she was able to resolve the Doctor on Demand concern with another Accolade Health Assistant by connecting though ********. The Complainant was also able to speak with the Accolade Supervisor to further resolve and deescalate the issue. Accordingly, Accolade requests that the complaint be resolved and closed.
  We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.
  

  Regards,

  Director, Customer Support 

  Customer response

  07/21/2023

  [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 made by the business in reference to complaint ID ********, and find that this resolution is satisfactory to me. 
  I have since had all the issues resolved by a much better associate- thank you for coaching the first associate so that this does not happen again.
  
  Regards,
  
  *****************************
  

• Initial Complaint

  06/22/2023

  Complaint Type:

  Product Issues

  Status:

  Answered

  More info

  ****** ********** directs all members to Accolade to resolve claim issue and appeals. When calling ********** the member is directed to Accolade. I received a denial from ********** and was informed that I could upload my appeal letter via secure message on Accolade. I did so, and then Accolade sent me a message that the do not manage this. Accolade claims to help members with claims, and ****** ********** directs their members to them, but they aren't actually facilitating any help for the consumer. This is a waste of healthcare dollars and simply a wall that is being created between the consumer and the insurance company.

  Business response

  07/24/2023

  July 5, 2023

  Dear *** *******:
  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.
  CONSUMER COMPLAINT: Complainant alleges she is directed to Accolade for assistance in filing an appeal, however Accolade cannot submit an appeal on her behalf.
  COMPLAINT RESPONSE: Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving our member experience.
  By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employee and dependent members of such employers’ group health plan (“member”) in better understanding their benefits, their personal costs and assisting them to better make efficient use of the healthcare system. In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for members. Although Accolade is able to support members in navigating their healthcare benefits, Accolade is not responsible for making claim determinations, coding of medical services, inspecting medical records or related documents, billing the provider or member, or influencing whether a health plan ultimately decides to extend coverage.
  Accolade was contacted by the Complainant on April 25, 2023 regarding an unpaid hospital claim. The Complainant had paid up front for the surgery received, and needed this claim to be processed in order to receive a refund. On May 4, 2023 the claim denied due to lack of prior authorization. The Complainant was informed of the denial on May 11, 2023, and provided guidance by an Accolade representative to have the billing provider request a retrospective authorization.
  On June 20, 2023, the Complainant requested to file an appeal. The Accolade representative educated the Complainant on how to submit an appeal. Accolade’s role is to support its members in attempting to get resolution of their issues, but Accolade itself cannot submit an appeal on a member’s behalf. Accordingly, Accolade requests that the complaint be resolved and closed. We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.

  Regards,

  Director, Customer Support

• Initial Complaint

  04/28/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  I reached out to see what the pricing was for a test I needed done. The person I was speaking to took it upon themselves to call on my behalf without my permission. Then I wanted to escalate the situation to discuss what had happened and asked for a formal complaint. I was told I would not receive a resolution as they are not allowed to share the resolution. I think this is unacceptable and no one ever shouldve called on my behalf without permission. I am looking into the legality of that.

  Business response

  05/15/2023

  May 9, 2023

  Dear *** *******,
  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.
  Consumer Complaint: Member states that she would like a formal resolution to a complaint alleging that an Accolade representative contacted a provider, without express permission, to obtain the cost of ADHD Testing.
  Complaint Response: Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving upon our member experience. By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employee and dependent members of such employers’ group health plans (“members”) in better understanding their benefits, their personal costs, and assisting them to better make efficient use of the healthcare system. In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for members.
  Accolade was contacted via Mobile Messaging App by Complainant on April 28, 2023 for assistance in understanding the estimated cost for testing related to an ADHD diagnosis. As an advocate to the member, the Accolade Representative (AR) offered to call the Complainant’s provider to obtain an accurate cost estimate. When AR informed Complainant that she would call the provider, the Complainant did not respond for 8 minutes. The AR proactively contacted the providers’ office to obtain an accurate cost as soon as possible. The AR was unable to reach the provider and left a voicemail message requesting a call be made to the Complainant with a cost estimate for the ADHD test. The
  Complainant responded approximately 8 minutes later requesting that the AR not call on her behalf and was frustrated that this call had already occurred.
  The AR explained to the Complainant that a provider helps to determine a cost estimate, so it is often a necessary step in us providing such estimate to our members. The AR believed she was following Accolade’s process steps by providing personalized concierge services to help the Complainant better understand the costs associated with this test.
  Before ending the Mobile Message App interaction, the AR stated that she would not call the provider back and would submit an internal complaint to a supervisor on the Complainant’s behalf. The AR explained that the Complainant’s issue would be escalated reviewed, and a supervisor would be back in touch for a resolution.
  The complainant requested an immediate resolution of her complaint but did not want to speak to a supervisor to resolve. The AR explained that any coaching/disciplinary action would be taken as appropriate but the results of those actions would not be shared.
  Since learning of the Complainant’s issue, another AR was able to respond to the request by providing the Complainant with the Health Plan benefit and explaining that the provider would know the cost since they contract this amount with the Health Plan directly. The AR suggested that the provider contact the Health Plan’s provider services to verify insurance and give a quote for the visit. AR suggested that if the provider refuses to follow these steps, then Accolade Support can call them on our recorded line to ask about their cost estimate or request that they print or email a quote to be sent to the address in the record.
  Accolade’s role is to support our members, including Complainant, in attempting to get resolution of their issues, but cannot itself provide an accurate estimate without contacting the provider directly. Accordingly, Accolade requests that the complaint be resolved and closed.
  We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.
  Regards,
  **** ********
  Director, Customer Support

  Customer response

  05/15/2023

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because in the screenshot you provided you proved I never asked or approved someone to call on my behalf. They just did it without checking. Thank you for proving what I said. How will you resolve it now?
  
  Regards,
  
  ***************************
  

  Business response

  06/14/2023

  May 9, 2023

   

  Dear *** *******,

  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.
  Consumer Complaint: Member states that she would like a formal resolution to a complaint alleging that an Accolade representative contacted a provider, without express permission, to obtain the cost of ADHD Testing.
  Complaint Response: Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving upon our member experience. By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employee and dependent members of such employers’ group health plans (“members”) in better understanding their benefits, their personal costs, and assisting them to better make efficient use of the healthcare system. In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for members.
  Accolade was contacted via Mobile Messaging App by Complainant on April 28, 2023 for assistance in understanding the estimated cost for testing related to an ADHD diagnosis. As an advocate to the member, the Accolade Representative (AR) offered to call the Complainant’s provider to obtain an accurate cost estimate. When AR informed Complainant that she would call the provider, the Complainant did not respond for 8 minutes. The AR proactively contacted the providers’ office to obtain an accurate cost as soon as possible. The AR was unable to reach the provider and left a voicemail message requesting a call be made to the Complainant with a cost estimate for the ADHD test. The Complainant responded approximately 8 minutes later requesting that the AR not call on her behalf and was frustrated that this call had already occurred.
  The AR explained to the Complainant that a provider helps to determine a cost estimate, so it is often a necessary step in us providing such estimate to our members. The AR believed she was following Accolade’s process steps by providing personalized concierge services to help the Complainant better understand the costs associated with this test.
  Before ending the Mobile Message App interaction, the AR stated that she would not call the provider back and would submit an internal complaint to a supervisor on the Complainant’s behalf. The AR explained that the Complainant’s issue would be escalated reviewed, and a supervisor would be back in touch for a resolution.
  The complainant requested an immediate resolution of her complaint but did not want to speak to a supervisor to resolve. The AR explained that any coaching/disciplinary action would be taken as appropriate but the results of those actions would not be shared.
  Since learning of the Complainant’s issue, another AR was able to respond to the request by providing the Complainant with the Health Plan benefit and explaining that the provider would know the cost since they contract this amount with the Health Plan directly. The AR suggested that the provider contact the Health Plan’s provider services to verify insurance and give a quote for the visit. AR suggested that if the provider refuses to follow these steps, then Accolade Support can call them on our recorded line to ask about their cost estimate or request that they print or email a quote to be sent to the address in the record.
  Accolade’s role is to support our members, including Complainant, in attempting to get resolution of their issues, but cannot itself provide an accurate estimate without contacting the provider directly. Accordingly, Accolade requests that the complaint be resolved and closed.
  We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.
  

   

  Regards,
  **** ********
  Director, Customer Support

  Customer response

  06/14/2023

  [To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed as Answered]
  
   Complaint: ********
  
  I am rejecting this response because: These are the same screenshots as last time. They just responded with the exact same response showing they have no interest in addressing the issue. And furthermore they've provided evidence that I did NOT authorize anyone to call on my behalf. They have yet to issue an apology or attempt to make this right. 
  
  Regards,
  
  ***************************
  

• Initial Complaint

  01/06/2023

  Complaint Type:

  Service or Repair Issues

  Status:

  Answered

  More info

  Hi, The ** system recently chose Accolade to process all customer service with their ***************** benefits recipients. I am trying to get a simple tech question answered: How can I personally submit claims electronically for an out-of-network provider whom I have already paid. I reached an Accolade employee yesterday evening (Jan 5, 2023). She could not answer the question. So she said she was going to talk to someone who could, and then she of course disconnected me. I called back. They kept me on hold and then offered to put me in a call-back list, and I offered the robot the information. About two hours later they called back and put me on hold and no one came to the phone. I tried again this morning (Jan 6 2023), and even a machine did not pick up the phone. Then I tried again this afternoon. Again: no person, but at least finally a pick up. Again the offer of the call-back. Again, after an hour's delay or so, the call back, which almost immediately put me on hold (again, no human contact), and then kept me there for another ten minutes. Don't know if this is worthy of your attention.

  Business response

  01/23/2023

  January 19, 2023

   

  Dear *** *******: 
  
  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond. 
  
  CONSUMER COMPLAINT:  Complainant alleges they are unable to get assistance with electronically submitting claims.
  
  COMPLAINT RESPONSE:  Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving our member experience. 
  
  By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employee and dependent members of such employers’ group health plan (“member”) in better understanding their benefits, their personal costs and assisting them to better make efficient use of the healthcare system.  In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for members.  Although Accolade is able to support members in navigating their healthcare benefits, Accolade is not responsible for making claim determinations, coding of medical services, inspecting medical records or related documents, billing the provider or member, or influencing whether a health plan ultimately decides to extend coverage.   
  
  The Complainant contacted accolade on January 5, 2023 for assistance with submitting claims electronically through the Health Plan portal. The Accolade Representative connected the complainant to the Health Plan tech support line but was unaware the call did not connect and ended. The complainant then called back the next day asking for claims submission support and Accolade advised of the claims submission process for submitting via mail as an alternative to electronic submission. 

   

  Since learning of the Complainant's issue, Accolade has contacted her to review the various options for claim submission.  Accordingly, Accolade requests that the complaint be resolved and closed. 

  
  We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.  
  
  Regards, 
  Rick S*******
  Director, Customer Support

• Initial Complaint

  08/19/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  I work for an airline and the health assistance phone number listed on the back of my health card diects calls to ********************** for any questions related my insurance coverage. In June I contacted Accolade to ask for a list of in-network dermatologists and was provided by the representative two dermatologist providers. The first one was ***************************************** in Aloiso Viejo, ** and the second one was *************************** of North County, Inc..I contacted *************************** of North County and made an appointment for Jul 11, 2022. I asked the representative that made my appointment if they accepted ***** PPO when making the appointment and was also told that my insurance was accepted. On 8/16/2022 I received a statement from *************************** stating that I owe an out-of-packet balance for services provided for in network. Prior to going to my appointment, I had also met all my deductibles and shouldn't owe any out-of-packet balances.

  Business response

  08/31/2022

  August 23, 2022  

  Dear *** *******:

  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.
  

  CONSUMER COMPLAINT: Complainant alleges she was not provided accurate information of the network status of a dermatologist causing her to incur additional out of pocket expenses.
  

  COMPLAINT RESPONSE: Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving our member experience.
  
  By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employee and dependent members of such employers’ group health plan (“member”) in better understanding their benefits, their personal costs and assisting them to better make efficient use of the healthcare system. In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for members. Although Accolade is able to support members in navigating their healthcare benefits, Accolade is not responsible for making claim determinations, coding of medical services, inspecting medical records or related documents, billing the provider or member, or influencing whether a health plan ultimately decides to extend coverage.

  Accolade was contacted by the Complainant on June 17, 2022 for assistance in locating an in-network provider. The Accolade Representative offered to complete a search and send the results through Accolade’s secure Mobile Messaging App however, the Complainant declined asking for assistance navigating the self-serve website to complete her own search. Before ending the call, the Complainant was provided with full in-network and out of network benefits for this particular Provider.
  Since learning of the Complainant's issue, Accolade has offered to contact the Provider on the Complainants behalf to ask if they will accept the in-network allowable amount they were paid and waive balance billing charges as the Complaint explained she verified at time of service that the provider was in her health plan network.
  Accolade’s role is to support complainant in attempting to get resolution of their issue, but cannot itself cause the issue to be resolved in favor of the Complainant. Accordingly, Accolade requests that the complaint be resolved and closed.

  We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.
  
  Regards,
  Rick S*******
  Director, Customer Support

• Initial Complaint

  06/04/2022

  Complaint Type:

  Billing Issues

  Status:

  Answered

  More info

  In March 2022 and I was going to quit my job so I though I would go to the doctor one last time before I lose the insurance that I pay for. I had some blood work done on this visit at my primary care doctor. Now the insurance paid what they were suppose to for the doctor visit but they paid nothing for the lab work. I called Accolade and once again they said there was a problem with the coding the doctor used. This time they called the doctor right away and spoke with the billing department with me on three way. When Accolade said there was a problem with the coding for the blood work the billing department asked what code was the correct one, and the Accolade rep said they couldn’t tell them what code to use. The billing department seemed to get frustrated with that answer and said they would put in a claim. The claim apparently didn’t solve the problem since I got the bill again and this time they said it was late. Rather than having to continue to take time out of my busy schedule going back and forth between Accolade and the doctor, I just paid the bill in full out of my own pocket.

  Business response

  06/17/2022

  June 15, 2022

  Dear *** *******:

  Thank you for bringing this consumer complaint to our attention, and for the opportunity to respond.

  CONSUMER COMPLAINT: Complainant alleges that health insurance claim denied due to service not being eligible for coverage.

  COMPLAINT RESPONSE: Accolade is always disappointed to learn that someone has had a negative experience, and we work hard to ensure that we are always improving our member experience.

  By way of background, Accolade is a personalized concierge service retained by employers in the U.S. to support their employee and dependent members of such employers’ group health plan (“member”) in better understanding their benefits, their personal costs and assisting them to better make efficient use of the healthcare system. In some cases, Accolade provides support to members in answering questions related to the bills they receive from the health plans and/or their healthcare providers, assisting members
  in understanding the health plan decisions to deny a claim and communicating with the health plan to understand the basis of the denial and identify opportunities for a desirable resolution for members. Although Accolade is able to support members in navigating their healthcare benefits, Accolade is not responsible for making claim determinations, coding of medical services, inspecting medical records or related documents, billing the provider or member, or influencing whether a health plan ultimately decides to extend coverage.

  Accolade was contacted by the Complainant on April 22, 2022 after having received a bill for lab work.
  Accolade determined the claim for lab work denied due to service received being not eligible for coverage. The Accolade Health Assistant contacted the prescribing physician who confirmed a code review would be completed by their office.

  Accolade’s role is to support its members in attempting to get resolution of their issues. On June 15, 2022, Accolade contacted medical health plan BCBS AL who confirmed this claim was incorrectly denied, and reprocessed the claim to apply the member’s lab work benefits. Accolade then contacted the member to inform of issue resolution, and will assist member in attaining a refund. Accordingly, Accolade requests that the complaint be resolved and closed.
  

  We greatly appreciate the feedback that we receive from our members and we strive to provide an excellent member experience. Please contact me with any questions or if you require additional information to support and respond appropriately to this complaint. We look forward to an appropriate and expedient resolution, and are happy to address any further questions.
  

  Regards,
  Rick S*******
  Director, Customer Support

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