Sonia Alio

Review of Health First

I am a member of the Gold Leaf plan. Apparently e...

I am a member of the Gold Leaf plan. Apparently each type of HF plan has separate offices, I have a much better experience with the Child Health Plus insurance. Here are the main issues with the Gold Leaf plan, with examples of my experiences:

Number of In-network doctors and the quality of the portal:
The list of in-network Doctors who take the insurance is EXTREMELY limited if not absent for some specialties. Don't get fooled by the listing that shows in the portal. Once you call almost no doctors or none take the insurance. Curiously, I found two doctors who take it who are not in the portal. The list is completely outdated and there is a lack of in-network doctors taking the insurance. And don't call customer "service" . All they do is go on the outdated portal themselves. Make sure to reserve about 3 business hours to make phone calls and take a calming tee if you need a doctor. You will be infuriated, unless you are ok with going to a clinic, wait for hours and wonder why you pay for the insurance.

Pre-authorizations for everything, including a bandage:
Yes, when you finally find a Doctor, they drive his/her office crazy with pre-authorizations for everything. They are processed by 3rd party companies and take 14 days!!!! That is, if your Doctor's request gets approved. Plus they are not coordinated with Health First: when the doctor calls HF they say you need the authorization. Then they call the 3rd party office, they say they don't have the function delegated. So at the end, the doctor's office calls in circles to conclude that there is nobody assigned to authorize the treatment or evaluation that you need.

Billing:
The billing office for the Gold Leaf plan posts incorrect and unexplained amounts on the bills. It takes them over a month to update information so it may be that if you paid early, it always looks like you didn't pay the previous balance. Even though I paid well in advance (the 10th or 15th of the previous month), customer service was not able to clarify the discrepancies being posted. There is no way to pay online because there is no option to pay a different amount than the incorrect posted one.
After spending hours on the phone trying to find out what the problem is without finding an answer, one gets the menacing letter saying that they will cut your service, even though there is proof of timely payments for the premiums. Managers escalate your case but nothing gets resolved. Two weeks later you log in and the bill is still wrong.
Update: The portal finally shows the right amount. It only took 6 month and several, several phone calls.

Problems typically don't get resolved:
If you have any of the above problems, you may be able to place a complain over the phone. Different agents call afterwards and tell you that they will monitor phone calls and "take it from there". This is as far as I got. Checking on old phone calls may help their company improve their service, but it doesn't help you as a patient when you are in need of medical services that are time sensitive, alas, you are in pain. You continue to have the problem which is unresolved. Another response that I got from an agent was that I should go to NYState of Health and find a new insurance ?!