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I absolutely can't understand how this company gets away with what they do, and do not do. None of the providers in my area accept the insurance even though member services via phone and their in network provider online search lists a ton who do. When you call or see the providers, they say they will not accept it. When I call Allied member services to find out what I can do, they tell me they can't help because they are just a 3rd party administrator. When I ask Aetna (the company Allied uses as a network and pricing guideline for the providers) Aetna will not help because we are not actually Aetna members. Then, Aetna tells me to call Allied about it. Once, Allied told me the provider has to bill Allied and use the Aetna fee guidelines because the provider has to honor their contractual agreement with Aetna. Then, I told my provider this and they explained to me they opted out of 3rd party billing in their clause with Aetna. When I called Allied and told them this, they said they could not help me straighten this out. Then, 2 more providers will not take the insurance and allied and the providers told me I can pay out of pocket and then submit the claim. Come to find out, the providers will not use the Aetna pricing and Allied will only pay the less amount which is the Aetna pricing. The providers will not provide the Network discount, they I wasn't reimbursed the total amount I paid. Then, another provider actually bill Allied. Then, Allied paid them but put on my claim document I viewed that a portion of it was adjusted by the provider because of the network discount. Then, I receive a bill from the provider for the amount Allied has documented in my claim details saying it was adjusted and I owe nothing. Allied will not hold any of the providers accountable even through they confirm the provider absolutely are in network and that they have not removed themselves from the network. Allied told me the providers are not honoring the Aetna contract if they don't bill Allied and if they don't give us the network discount. But, when I called Allied to tell them the providers are not honoring the contract, they literaly said ver betem, "there isn't anything we can do to help you. We are just 3rd party administrators." If Allied will not provide any service except receive claims and possibly pay some of the billed amount, (they don't even provide correct in network information) and Aetna (our network) will not provide any network services such as speaking with me over the phone or online about who is in network and will not hold providers accountable for not honoring the network contract, then who is actually my insurance company???? Aetna says they will not speak with me about anything at all whatsoever because I am not an Aetna member. Allied tells me they will not help with coverage information or network solutions because they are just 3rd party Administrators. One of my providers who Allied swears is in network, says they will not bill Allied because they can't bill them electronically and the provider does not bill insurance companies via paper/mail. Allied says they have to. My provider, again, says they opted out of 3rd party billing in their network contract with Aetna. Allied has no idea if they did or uf any other provider did, because they do not handle the network side of it - Aetna does. Aetna will not speak with me. I did some research and found the Allied does accept electronic claims but only via ChangeHealth, which is an expensive system that providers have to pay a lot of money for a membership to use - Allied justifies with by saying providers also have the option to bill by mail. It is extremely rare to find providers who are willing to bill by mail these days, because there's so many issues with processing taking forever and getting denied over and over after they change each thing each time and continue to mail in amended claims over and over again - which is exactly what Allied does when billed. Allied's only solution to any of this is for me to self pay and then submit the claim myself. I do NOT trust that!!!!! I have now read TONS of reviews on Allied where people couldn't find a provider who would bill Allied, so they self paid and submitted the claim - and the claim was denied. Most of the time because the provider was out of network. Even though Allied tells us they are in network, their Aetna Signature Administrators PPO provider search says they are in network. But, when I call Allied to tell them the provider will not bill Allied, they just keep telling me the provider is in network and is in the wrong. Now, if I self pay and Allied denies due to not being network - they can just say the one true way to find out if a provider is in network is to ask the provider. The thing is NOT ONE SINGLE provider within 50 miles of our home will honor the contract. They are in network with Aetna but not Aetna Signature Administrators PPO (ASA). I researched ASA. They are this strange service that offer a network service to these what they refer to as "payers" - not actual insurance companies. These payers handle receiving, approving, and paying the claims, and they can use the ASA network to attract members (including employers looking for low cost health coverage for employers) and attract providers to accept their insurance. ASA claims in their advertising to these payers and providers that the ASA network is considered and treating the same as the Aetna PPO network the providers already have contracts with. It lists ASA provides network information and manages network issues, and provides resolution services, etc. It also lists the "payers" are responsible for member services and claims, etc. Then, it contains a list of all of the payers who use ASA as their network. There is seriously only about 15 payers within the entire U.S. who uses ASA. I looked up all these payers, and they ALL have tons of reviews with the same issues over and over - told by insurance company the providers are in network. The providers refuse to bill the insurance company. The insurance company's only suggestion is to self pay and submit claim for reimbursement. Then, the provider will not provide network discount. Then, the insurance company will not pay the amount they say the provider should discount. So, the member doesn't get that money back. There's also a ton of reviews saying these compaines deny their claims because the provider is out of network after being told they were in network. I mean, if not a single provider will bill the insurance and the insurance company repeatedly confirms the provider is in network...what else can do you but just choose one of the providers and self pay? Then, the insurance company denies the claim and will not reimburse the member saying the provider is not in network. It is the frame of mind these "payers" have. They are not member service driven. They simply care about receiving claims, reviewing them, and either approving or denying and the maybe paying them. They are not well-rounded companies. They tell people they a wonderful network, but it is a racket. There is no one who is willing to speak to the patients about issues with the network. And, that is where most of the problems lie. Also, Allied has this "I do not care, you are bothering me" attitude every time I have asked for their help. They provide me with a reference number at the end of the call, but then when I try to provide to someone later explaining that person told me something different, they will not take responsibility for whatever incorrect information I was given. It is also extremely unprofessional to tell members their doctor's offices are being unlawful because they are not honoring the Aetna network contractual agreement when the provider they are referring to opted out of 3rd party billing in their contract. Allied says this because they don't know when providers have opted out of 3rd party billing, because ASA still lists the providers as in network on the provider search specifically for ASA - not just Aetna in general. And, any and all people who are in the ASA network , have 3rd party billing insurances. But, when you try to resolve this with Aetna, they will not speak with you because ASA network users are not Aetna members. And, ASA clearly states on their ad. that they do not provide member services, but will privide network issues resolution. In order for Aetna do anything with an issue, the payer (Allied) need to reach out to Aetna about it. But, Allied will not do that. They just do the claims processing. ASA provider search has a button to report inaccurate info on the providers. When you click it, you have multiple choice options on what is inaccurate. The closest thing is "provder no longer accepts Aetna network" Which is not the case with all of these providers. They do accept the Aetna network. They will not deal with 3rd party administrators with ASA. There's no way to even report the issue to Aetna. I chose "other" and in order to submit it, I had to choose what type if Aetna I had. ASA was not an option. I couldn't move forward until I selected one, so I just randomly chose one. I submitted my issue about my provider unwilling to bill Allied, and he was on the ASA in network list. Allied just looks at the same exact provider list online when you call to ask them, so that is useless. I explained this too. I also explained the provider will not honor their network contract, will not bill Allied nor give me the network discount. I explained Allied will not help because they say they are just 3rd party administrators. Aetna responded and told me that provider is not in my plan. That was it. That is all they said. I responded and said the ASA lists him as in network and Allied has repeatedly told me he is in network. They responded and said "call the member services number on your card" - which is Allied.

Also, Allied's website says this is just a summary, see plan document (and detailed plan document) for full explanation of benefits, and says to go to the same website I am on to get this detailed plan document. I have looked everywhere on the website and the detailed plan document is nowhere on the website. All the logical places for it, says "see www.alliedbenefit.com for detail plan document".....which is the site I am on.

In the end, Allied can deny the claims because they can say I am responsible for confirming with the provider whether or not they are in network. The thing is not a single provider on their network list has said yes, they accept the insurance - even after I explain the network is ASA. So, something is wrong. Allied member services says all the providers are in network. How do I really confirm it? In the end, Allied can deny the claim and not reimburse me by saying I should have confirmed with the provider even though none of them will bill Allied. If they were in network they would bill Allied. So, how do I see the doctor and be confident he or she is in network?????????

I swear, this should be illegal.

I am attaching the ASA advertisement I referred to.

Reason of review: Poor customer service.

Preferred solution: Provide assistance in identifying actual in network providers, holding the providers accountable in honoring the network contract, and if they can't do that, get me in touch with someone at ASA who can..

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