Medica Health Plans

"This is the worst insurance company! My wife had a surgery on her foot that was prior authorized ahead of time as in network. Medica even has the phone record of it as well as the hospital. Over 6 months later we are still fighting with Medica as they have it billed as out of network for over $8k. Do not use this company. I think this company should be looked into by a news outlet for illegal billing practices."

"Medica is the worst insurance company I have ever worked with. Consistently, they have not paid out claims, even in situations where I explicitly received a prior authorization. I have also phone conferenced with Medica and my clinic about claims that then, had to be followed up again through a 3-way phone conference because steps were not taken to resolve the issues. In one instance, I received a new bill for claims that were 18 months old, and I had already fought Medica for 6 months about. Sometimes, the customer service agents have been able to resolve my issues, but only if I persisted in my inquiries. I have spoken to a few good people on that end. However, the trouble that I had to go through while struggling with health issues outweighs any positive experience I could possibly have on the phone. Tonight, I learned that they did not cover a routine dermatology visit at my primary care clinic. I attempted to contact them over email, only to find their online system is not working. So, they are receiving this review instead. I encourage employers and individuals to seek their medical insurance elsewhere."

"Wish I could give a happier review, however, Medica decides what is medically necessary— not your provider. After having met my $3000 out of pocket maximum —My provider—who actually met me in person—& examined me—ordered a respiratory panel. Medica determined the test was not medically necessary based on prior medical history. I appealed their decision— both internally & externally & Medica (who chooses the external reviewer) of course won the appeal. Imagine that! Provider even went to bat due me explaining test was medically necessary. Welcome to present day health care— your health insurance dictates your care— not your provider.. As an influencer I will ensure my 900,000 followers are aware of Medica’s actions & poor coverage.."

"This is truly the worst insurance company in existence and that's saying something, since they're all pretty awful. For one thing, their member portal never works. The link on the website has been broken for months for several of their plans. Apparently, you need to type in myplan instead of mymedica for a few of the provided plans. You'll only know that though if you call them. Then once you get onto the portal, good luck finding your statements. They'll send me endless emails saying "check your explanation of benefits," except I can't because it's literally never updated. It always says "no claims have been made" which is untrue. Oh also, when you click the provided link in the email, that takes you to the wrong/broken portal as well. Awesome. Customer service is basically non-existent. I've spoken to many reps and have had exactly one who sort of knew what she was talking about and was even remotely helpful. Every other rep just seemed confused and completely uninterested in actually helping. Or I get conflicted information, because no one there seems to know what's going on ever. Their claims process is a joke. Since their system can't figure anything out, I have to call and ask my doctor to re-code a repeating appointment every time because they charge me a copay when I'm not supposed to get one for these preventive appointments. Medica is the only insurance my clinic has to do this for, everyone else is able to figure it out. All documents sent to us at the beginning of the year were wrong. We chose the plan we did based off of these documents and were extremely unhappy when we received a four figure bill for insulin, when every plan document said it would be capped at $25 a month. Again, customer service was non-existent. They told me well sorry, our documents were wrong, but go ahead and appeal and I've yet to hear anything. This was months ago. Finally, we're going through the process of purchasing some new durable medical equipment. My spouse always hits the deductible within a month or two of starting the year/a new plan, so he's been out of the deductible for a long time. The medical device company called Medica for pre-authorization and they said he hadn't paid any of his deductible. Maybe they'd know he's paid the deductible and is well on his way to meeting out of pocket maximum if their system actually worked at all. They are truly incompetent. I'm extremely thankful my employer is switching to a new provider in the new year. If you have an option, do not go with Medica. If you're using the state exchange, do not go with Medica. Save yourself the time and trouble. I have never left a Google Review before, but they infuriate me so much, I'm taking the time to warn anyone who has the chance to avoid them."

"I pay over $1000 a month for a really high deductible. For some reason the auto pay didn't go through. Received notification a month later saying if I didn't pay by a specified date my plan would be canceled. When I logged in to pay I found my account canceled even though the date I needed to pay by was weeks away. Called to file an appeal and was told they would email me the appeal form. It never came. Called again, and the appeal never came. Now on my third time and still have yet to find anyone who can help me."