Business Profile

HMOs

CareSource

Complaints

This profile includes complaints for CareSource's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

55 total complaints in the last 3 years.
10 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. 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.

Initial Complaint
Date:03/11/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have breast cancer and was planning surgery with my provider, an excellent surgeon, *** ****** *******. Got a letter from Caresource, Ohio, Bronze, Marketplace, on 2/28/24 (attached) saying she "will no longer be contracted with Care Source after 4/26/2024." There was no explanation as to why. I contacted my Doctor's office that is part of a large hospital network that is contracted with Caresource and they said that was in error because they were contracted with Caresource and so is she. When I first recieved the letter I was very emotionally distraught worrying that suddently I could no continue with my cancer doctor who I trust. I called Caresource and they could not give me any cohernt information. They would not investigate the problem, just said she wasn't in the network. All of their represenatives are in Asia (e.g., the Phillipines) and could not give me any information and were very rude.
Business Response
Date: 03/21/2024
Upon review of the concerns noted in the
members complaint and to protect the members PHI, a Member Services
Representative contacted the member directly on 3/18/2024 to discuss their
concerns in detail. The Member Services Representative was not able to reach
the member by phone so they tried to leave a voicemail but it was full and unable to leave a message. The Member Services Rresentative sent a trying to reach you letter on 3/18/2024. To date no return call has been received. We appreciate the
inquiry. Please contact us if we can
provide any additional information. Thank you
Initial Complaint
Date:03/05/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
They shut off my insurance after I paid and called them up last week. I go to check this week to find out I can't get my script filled because they ended my service LAST YEAR!! But I had insurance last week. Worst insurance ever.
Business Response
Date: 03/14/2024
Upon review of the concerns noted in the
members complaint and to protect the members PHI, a Member Services
Representative contacted and spoke to the member directly on 3/8/2024 to discuss
their concerns in detail. As a result of the discussion with the member, we
were able to fully resolve the issue and the member expressed no additional
questions or concerns at that time. We appreciate the inquiry and believe this
resolves the issue. Please contact us if we can provide any additional
information. Thank you
Initial Complaint
Date:02/29/2024
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
CareSource is not following their policy of disenrollment which is listed online. It states that you can leave CareSource for the following reasons: When you have a reason to change, such as:
You want to be on the same plan as a family member
You need care or providers that are not offered in the CareSource network
You got poor quality care

I am unable to find a psychotherapist. They also cannot provide me with the provider that is recommended by my psychiatrist. I’ve also received poor service in dealing with pre authorizations with caresource. They call me constantly, and I am honestly tired of dealing with them. Suffering from PTSD and Major Depression, the last thing I need is to be fighting with a company over getting the care I need to better myself. They only want the state of Georgia to keep paying them, and they could care less about the needs of the patient. They are not honoring their policy l, they are instead trying to find loopholes to get me to stay and this has been the most stressful process I’ve been through in a while. Most providers hate dealing with CareSource, because of their rigid policies. My complaint is valid. They need to allow me to go to a managed care plan that is offering the services I need…they can’t provide them.
Business Response
Date: 03/08/2024
Upon review of the concerns noted in the non members complaint and to protect the members PHI, a Member Services
Representative contacted the member directly on 3/8/024 to discuss their
concerns in detail. The member had contacted the plan in the past regarding the issue. The Member Services Rep offered to locate an in network but member declined. The Member Services Representative was not able to reach
the member by phone so a secure email was sent with the plan’s findings in
detail on 3/8/2024. We appreciate the
inquiry and believe this resolves the issue. Please contact us if we can
provide any additional information. Thank you
Initial Complaint
Date:02/16/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am writing this to because CareSource denied coverage for my newborn daughter, ****** ***. As per KY state law (and as was written in the policy), my infant is covered for the first 31 days of her life. I was told by the insurance sales rep and by an employee in India with Member Services that all I needed to do was use my insurance card for my newborn and that she would automatically be covered. However, my newborn’s hospital bill during our stay in the maternity ward at Baptist Health has been denied, as have her first two pediatrician visits with Metro Pediatrics. I canceled my insurance policy on December 31, 2023 because I moved out of state. Her doctor visits (and birth) occurred BEFORE the policy was canceled. Therefore, CareSource is required to cover her medical bills. I have more than paid my out-of-pocket max ($9,100) so my balance should equal $0. I will be filing a complaint to the Kentucky Attorney General and the Kentucky Dept. of Insurance. Denial of my daughter’s coverage under my plan is immoral, egregious, and overtly illegal. No insured person should have to file an appeal with their insurer over something like this.

“The Kentucky Office of Insurance takes the position that KRS 304.17A-139(3) advises that… the implication is that payment of a specific premium or fee and the application of a separate deductible shall not be applicable to coverage of a newly born child during the first thirty-one (31) days after the date of birth. Rather, payment of a specific premium or fee may only be charged for coverage that begins after the first thirty-one (31) days from the date of birth have passed.”

Baptist Health, Louisville, KY, Dates Of Service: 11/20/2023 - 11/22/2023 for the amount $6,302.09

Metro Pediatrics, 11/20/2023 and 11/27/2023 for the amount of $967.00
Business Response
Date: 04/05/2024
Upon review of the concerns noted in the
members complaint and rebuttal and to protect the members PHI, a Member Services
Representative contacted and spoke to the member directly on 4/5/2024 to discuss
their concerns in detail. As a result of the discussion with the member, we
were able to resolve the issue. We appreciate the inquiry, please contact us if we can provide any additional
information. Thank you
Initial Complaint
Date:02/01/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.

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.

Sincerely,

***** *****
Business Response
Date: 02/09/2024
Upon review of the concerns noted in the
members complaint and to protect the members PHI, a Member Services
Representative contacted the member directly on 2/8/2024 to discuss their
concerns in detail. The Member Services Representative was not able to reach
the member by phone so a secure email was sent with the plan’s findings in
detail on 2/8/2024. We appreciate the
inquiry and believe this resolves the issue. Please contact us if we can
provide any additional information. Thank you
Customer Answer
Date: 03/20/2024
Consumer’s Duplicate Complaint:
I filed a complaint over a month ago for paying for insurance and not having it, and or one unauthorized payment coming out of my bank account. I have NOT received the refund and when I call I get the run around by customer service. I need my money refunded. I have a limited income and this is unacceptable.

Consumer’s Desired Resolution:
Refund
Business Response
Date: 04/05/2024
Upon review of the concerns noted in the
members rebuttal and to protect the members PHI, a Member Services
Representative contacted the member directly on04/04/2024 to discuss their
concerns in detail. The Member Services Representative was not able to reach
the member by phone so a secure email was sent with the plan’s findings in
detail on 04/04/2024. We appreciate the
inquiry and believe this resolves the issue. Please contact us if we can
provide any additional information. Thank you
Initial Complaint
Date:01/29/2024
Type:Customer Service Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.

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.

Sincerely,

**** *******
Business Response
Date: 02/08/2024
The member was contacted on 2/08/2024 to advise that this issue has been resolved in their favor.

Thank you,

CareSource
Initial Complaint
Date:01/26/2024
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
CareSource bills would come too late to pay by mail in order for the bill to get there on time. So like an idiot I signed up for their auto pay through my credit card. I have canceled this insurance through the marketplace December 2023. I tried to cancel the auto pay using the phone number that was given. But this phone number no longer works. I also tried to cancel auto pay through signing up through the account online. But it will not let me sign in so I could cancel. I called them and finally got a human to talk with. When trying to reset the password the page they send me to is an old timed out page. I called my credit card company and could not get a human or an option to talk about stop paying said bill. So I wrote them a letter. I have been charged twice now on my credit card. I don’t know what to do. If their system work or the phone number they keep giving me is the wrong number and it won’t work. so if they would give me a real number instead of bogus number, I would’ve canceled it already. Thanks for any help that you can give me.
Business Response
Date: 01/31/2024
Upon review of the concerns noted in the
members complaint and to protect the members PHI, a Member Services
Representative contacted and spoke to the member directly on 1/30/2024 to discuss
their concerns in detail. As a result of the discussion with the member, we
were able to fully resolve the issue and the member expressed no additional
questions or concerns at that time. We appreciate the inquiry and believe this
resolves the issue. Please contact us if we can provide any additional
information. Thank you
Initial Complaint
Date:01/08/2024
Type:Billing Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
No it is not resolved.

I spoke with a representative from Care”Source in mid January, a ******* *. explained that they had determined there was a computer programming error with regards to Tax Identification numbers (TIN) within their Find-A-Doc tool on their website that had caused my problem. They said this was a problem on their part and they were correcting it. I requested a formal letter explaining what had occurred and the fix they were putting in place to ensure I didn’t run into this in the future and had record of their negligence on my part. She assured me that a letter would be sent to me explaining the problem that had occurred and the fixes they were putting in place. It is now February and I have not received a letter from CareSource as I requested. So from my perspective this complaint is not resolved. Thank you for your assistance on this matter.
Also, CareSource sent conflicting information to the Ohio Department for Insurance saying nothing about the computer glitch on their part with regards to the Tax Identification Numbers (TIN), but rather putting the responsibility on the doctors to enter the information correctly. I am still quite frustrated with this whole situation with CareSource.

Sincerely, ***** *********
ot gotten a response in the mail. However, on December 29, 2023 I did get voicemail from a Fred from CareSource stating he was following up on my grievance appeal. He did not leave a callback number. I did not answer the call because I didn’t recognize the phone number. He did call me back on January 2, 2024 and I explained to him my grievance appeal. I had him look up my two doctors, who I had already verified through HealthCare.gov as accepted providers on CareSource’s site in December 2023. I did this before signing up with CareSource for 2024 coverage. The two doctors are *** ****** ******l and *** ****** ******** both associated with Cleveland Clinic. Initially Fred said they were not listed as CareSource providers and then he asked me if both doctors were associated with Cleveland Clinic which I responded, yes, they are. He then said he needed to look into something and would get back with me. The next day he called back and left me another voice mail stating he tried to get some answers from Cleveland Clinic but could not get any information from them and thus he stated that both doctors were not in CareSource’s list of providers and he would be following up with a letter being sent to us denying our grievance appeal.
These responses from CareSource are unacceptable. I have been getting different answers from each customer service rep, one acknowledging that my doctors are in their network and he will add the information into the system and the other two saying otherwise? I have screenshots from the CareSource website showing *** ****** ****** as one of their providers dated December 11, 2023. I have never experienced such frustration or incompetence in 50 years of dealing with hundreds of businesses and services. I cannot understand how their customer website and customer representatives can be so unhelpful and incompetent and the fact that they do not give you a number to call back is also ridiculous. I expect this to be resolved appropriately and apparently it is going to take an outside agency to hopefully get it resolved. I really have to question the leadership team of this organization and really would like to hear what they think of this type of customer experience, overall I estimate I have spent 8 hours of my time dealing with this issue on phone calls and researching how to get this fixed.
Business Response
Date: 01/18/2024
On 12/11/2023, the member filed a Grievance regarding this issue.
On 1/3/2024 a member of the Grievance team contacted and spoke with the member to
advise of their findings. The Specialist offered to assist in locating a new
provider, but the member declined. On 1/8/2024
the member filed a complaint with the Ohio Department of Insurance as well as
the Better Business Bureau. The issue was researched and on 1/17/2024 a Issue
Resolution Specialist contacted the member and provided the plan’s findings.
The member expressed understanding of the resolution and requested a letter
with the information be mailed to him for his files. We appreciate
the inquiry and believe the members issue is resolved. Please contact us if we
can provide any additional information.
Business Response
Date: 02/22/2024
Upon review of the concerns noted in the
members rebuttal and to protect the members PHI, a Member Services
Representative contacted the member directly on 02/21/2024 to discuss their
concerns in detail. The Member Services Representative was not able to reach
the member by phone so a secure email was sent with the plan’s findings in
detail on 02/21/2024. We appreciate the
inquiry and we believe this resolves the issue. Please contact us if we can
provide any additional information. Thank you
Initial Complaint
Date:12/05/2023
Type:Billing Issues
Status:
ResolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.

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. Caresource indicated that they paid the bills yesterday (December 7th, 2023). I called the companies but they said it can take 4-8 weeks for the payment to show up so I will follow up with them then to make sure that its paid.

Sincerely,

******** ******* ****** where it says the end date of the mistake the other insurance did in my file. Caresource even told me I have to get a bill sent to Anthem , have them deny it and then get it sent to them for approval but Anthem said that they cant accept the bill because i was NOT active with them on the 31st!! As soon as 12am on the 31st started I no longer had insurance. Every time I call is someone new, they cant find my old information and tell me they cant do much beside me filing a claim again. I already have 1/2 bills in collections because no one wants to help me. One time they even said they tried to reach me through my phone and letters home. I didn’t receive anything. I always have my phone beside me because of work!
Business Response
Date: 12/07/2023
Upon review of the concerns noted in the member's complaint and to protect the members PHI, a Member Services Representative contacted and
spoke to the member directly on 12/07/2023 to discuss their concerns in detail. As
a result of the discussion with the member, CareSource was able to fully resolve the
issue and the member expressed no additional questions or concerns at that
time. We appreciate the inquiry and believe this resolves the issue. Please
contact us if we can provide any additional information. Thank you.
Initial Complaint
Date:10/30/2023
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.

Complaint: ********

I am rejecting this response because: The issue has not been resolved.

Sincerely,

****** *****take Dentaquest. Mid October 2023 I gave up and went to a out of network dentist and paid for the partial myself. I am requesting an investigation on Dentaquest as well reimbursement for my partial. Lastly, I am having issues with Caresource representatives over the phone when attempting to file a new grievance. They are creating resistance and keep bring up that I have been giving information for a specialist. However, what they are refusing to understand is that because specialist information was giving, doesn't mean that the specialist accepts the insurance. Caresource reps have been intentionally lying on behalf of Dentaquest. I have repeatedly called Caresource and Dentaquest to get assistance with reimbursement for the partial. However, I am getting the run around by Caresource specifically in regards to correcting this matter. Caresource is 100% aware of what is going on with Dentaquest it is no secret. I am paying for insurance that I cannot use when needed. Caresource Bronze
Business Response
Date: 11/09/2023
Upon review of the concerns noted in the members rebuttal and to protect the members PHI, a Member Services Representative contacted and spoke to the member directly on 11/7/2023 to discuss their concerns in detail. As a result of the discussion with the member, the member services representative advised as soon as next steps was provided which should be by the end of the week, the member would be contacted and advised. We appreciate the inquiry and believe this resolves the issue. Please contact us if we can provide any additional information. Thank you
Business Response
Date: 11/16/2023
Upon review of the concerns noted in the
members rebuttal and to protect the members PHI, a Member Services
Representative contacted and spoke to the member directly on 11/2/2023, 11/3/2023, and 11/7/2023 to discuss
their concerns in detail. On 11/13/2023 the member contacted the plan directly for an update. On 11/16/2023 a detailed message was left for the member with the approval and to contact the Member Services Representative directly if additional questions arise. We appreciate the inquiry and believe this
resolves the issue. Please contact us if we can provide any additional
information. Thank you
Customer Answer
Date: 11/16/2023

Complaint: ********

I am rejecting this response because: The information submitted by the representative is accurate as far as information conveyed on the dates documented. However, the issue has not been resolved. I did receive information via voicemail and phone calls. However, I have not yet been refunded/compensated in this matter as of Thursday 11/162023. There is a lot of back and forth he said, she said. Nothing in writing concrete that I will be properly reimbursed by Dentaquest. Stop trying to close the issue while it is till on going, this is why we are here in the 1st place. The issue has not been resolved! Please stop submitting messages that the matter has been resolved until it is REALLY resolved! THIS MATTER HAS NOT BEEN RESOLVED!

Sincerely,

****** *****
Business Response
Date: 11/27/2023
Upon review of the concerns noted in the members
rebuttal and to protect the members PHI, a Member Services Representative
contacted the member directly on 11/20/2023 to discuss their concerns in
detail. The Member Services Representative was not able to reach the member, but
was able to leave a voicemail for a return call. The member returned the call on 11/21/2023
and the Representative advised the member the provider agreed to send in a
claim and once paid the provider will reimburse the member. The member is
working closely with a CareSource Member Representative to address all their
concerns. The member will be contacted again once we have a complete resolution
regarding the refund and the additional questions. Please contact us if we can
provide anything additional. Thank you.

Customer Answer
Date: 11/30/2023

Complaint: ********

I am rejecting this response because: I spoke with Dentaquest on today 11/30/2023. Per the representatives that I spoke with. Dentaquest do not have a record of a claim reimbursement for me. Basically, they are stating that they do not know what Caresource representatives are even talking about. My provider submitted the claim to Dentaquest over a week ago. Additionally I spoke with someone from Caresource on behalf of Ebony that person that has been handling this matter on Monday. She stated that Dentaquest spoke with my provider in regards to expediting the refund at 1:06 pm on Monday11/27/23. However, my provider stated that they did not speak to anyone. Who's lying?? I have not received the $800 reimbursement. In addition, this is an example of what I have been enduring since February 2023. This matter has not been resolved.

Sincerely,

****** *****
Business Response
Date: 12/07/2023
Upon review of the concerns noted in the members rebuttal and to protect the members PHI, a Member Services
Representative contacted the member directly on 12/5/2023 to discuss their
concerns in detail. The Member Services Representative was not able to reach
the member by phone. The member contacted the Representative and advised they had spoken to the provider several times and they reassured him they will refund him once payment is received. On 12/6/2023 the Member Representative spoke with the member to advise the claim did pay and it could take some time for it to be released to the providers account. The Representative advised that the provide will followup with the member once the payment comes through. The member didn't have any additional questions at this time. Please contact us if we can
provide any additional information. Thank you
Customer Answer
Date: 12/11/2023

Complaint: ********

I am rejecting this response because: I have not received my reimbursement. Per the phone conversation over a week ago. The dentaquest representative along with the caresource representative stated that I would receive the refund within 3-7 business days. It has pasted 7 business days. Dentaquest continues to mislead and play games with this matter. This matter has been very stressful and unfair. I am escalating this issue as f today.

Sincerely,

****** *****

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