Metroplus Health Plan

I have had MetroPlus since the beginning of January, 2016 and there has been an issue at every turn. If you can avoid using MetroPlus, please do and you will save yourself a lot of time and unnecessary frustration.
1. I have paid my premium on-​time every month, however on each instance when I’ve used my MetroPlus insurance, I’ve received a bill for the full balance with a note that I was not insured at the date of service. Each time I’ve called MetroPlus and spent close to an hour on the phone to get the issue resolved. Each time they tell me that I was in fact insured and it was simply a mistake. They then say that they will re-​process it and it will not happen again. It then happens again. Each and every time.
2. When going to pick up a Rx I was told that they system showed I was uninsured. I again spent a lengthy amount of time while at the pharmacy, on the phone with MetroPlus.
They again told that it was a mistake and finally rectified it. Same thing happened next I had to pick up a Rx.
3. They send Explanation of Benefits but there are always mistakes on them. I will receive one that says I have $ 42.01 remaining on my deductible and the next will say I have $ 2,000. No one can ever seem to give me an explanation of why this is and the problem persists.
4. The customer service is about as bad as it comes. The last person I spoke to was downright nasty. I could not believe the way that this woman spoke to me.
AVOID!!!

AVOID AT ALL COST!!! Took me 2 months, several emails (no reply ever), 3 calls and 1 call to NYS Health Dep to get my card. Absolutely garbage. And they told it’s not their fault I paid two months for nothing. Supposedly the first card got lost in the mail. But some miraculous way all the bills found me well. F*** off with that bs.
Then when you get the card and see what they signed as your PCP. And where. WOW. Try calling doctors on their list to change your PCP. Good luck! No one takes metroplus. Their lists are not up to date even the slightest.
This plan is pointless. And the best thing is I’m stuck paying over $ 400 a month for this for the next 8 months just not to get fined next year doing my taxes.
Do not sign up for the gold 1 plan or whatever. Sign for the cheapest just to avoid tax penalty.
Never again.

They are the worst I have had. I signed up their Exchange Plan eff 1÷1÷2016 and wanted to see a dentist. I called 6 dentists on MetroPlus online directory. Except one dental office where the receptionist had a bad attitude, all others either said they had never participated with Metroplus or they no longer participate with MetroPlus. That’s false advertisement. I have been on the phone for an hour and being bounced around between MetroPlus and its dental management company. Nice people but incompetent.
Do not sign up with them. I have to see if I could change coverage.

So it took me having to send an email and late night phone call just to find out that I was covered. They take your money and don’t even send a letter stating you will get your card in 10 to 15 days. So you pay for half a month of coverage, but I was told «that makes sense «. Yea I’m changing my insurance.

Horrible mistake i ever made signing up with this company. Its a scam. Paid my premium made over 75 calls and still no i. D cards or even temporary i. D cards. Reps on the phone talk bad about other reps within the company rather than helping me with my concern. Left over 69 messages no one has called back. Each time i am unlucky enough to speak to some one they tell me my account has not been created even after taking my money. 2 months later my account has still not been created. Some reps are rude and not prepared to answer your questions. Some give you misinformation. Some glorify their own expertise without really helping you. Obama care opened the gateway to idiots and insurance companies manipulating the populace. New york state health dept cant help you. Frustrated on many levels.

I enrolled with MetroPlus for 2016.
It’s been 2 months into the plan and I’ve never received an invoice from MetroPlus so I called them up to find out what’s my account balance and to make sure that future invoices will be sent. The customer representative that I’ve talked to was in a hurry, gave short flippant answers and refused to stay in the line while I make the online payment. Saying ‘refused’ is being gentle… The representative simply hung up the phone on me.
Just horrible, horrible customer service.

I have had MetroPlus now since the beginning on January and I have to say, I am pretty pleased with what is available to me for only $ 46 a month.
Here’s what I was able to do with the essential plan plus in only a month:
***Find a Dr. that is great and at a great facility***
I live in Brooklyn but work on the UWS so I decided to get my Dr located near work at NYU Lagone center. I was able to get my Dr. after a few short calls back and forth with the insurance and office AND book a physical in about a half hour. I went three days later, was seen and cared for in a great office, with no waiting time or hassle.
***Enroll in a mental health plan and see a mental health counselor every week for a $ 15 co-​pay***
I found a great counseling center in Park Slope, close to where I live and have been going for 6 weeks now. My counselor is a little young but I am working with her to develop a plan that will help me feel better about some problems that I have been having and the stress that day to day NYC puts on you.
***Find and book an appointment with a trusted dentist***
The referral is from a colleague of mine and I called and they except the MetroPlus health plan. I am fully covered for cleaning, x-​rays, fillings, and some other things I can’t remember.
Overall, even though I have just started with this health plan, I am pretty pleased with how much coverage I actually have. I had to work hard and take initiative in order to find the right person, care, and location for me and it paid off so far.

Unfortunately I’ve been hurt & sick enough across the years and states to be very familiar with health insurance, both good and bad. These guys are as bad as the very worst. I’ve successfully opened a case with The Office of the NY State Attorney General about these clowns.
They’re the ONLY health insurance who refuse to cover my Crohns Disease meds.
They won’t cover my son’s generic ($ 6) meds for a fever, saying «we don’t cover suppositories for anybody». OK geniuses, how are you gonna get the big dose of fever meds into my sick one year old?!? Also, why are you getting between me & my doctor?
They have a list of doctors that is completely inaccurate and woefully small. Five G.I. doctors for all of Manhattan?!? Many of the doctors on their list were filthy and sloppy or was a ghetto walk-​in clinics. Maybe I don’t feel like waiting 5 hours to get a referral. Our good doctors tried to take this insurance but said they were too difficult to deal with.
They have a $ 600 deductible for vision, making it essentially worthless.
Unlike others here, I never spent less than 8 minutes on hold before reaching someone and while the people were nice, they were stupid.
There IS good health insurance on the NY State exchange. These guys aren’t it.

Basically, all plans available through New York State of Health in NYC have very poor reviews online. It makes it very hard to choose a plan. Here are some positives and negatives for MetroPlus:
Positives:
— being able to reach a customer care representative without waiting on hold for more than 5 minutes.
— representatives are polite and always try to make sure they answered your questions
Negatives:
— They mail you your invoice every month, and in order to be able to pay online you have to have the invoice#. If for some reason you did not receive your invoice, you’ll need to call them and process the payment over the phone.
— Limited in-​network doctors. Mostly foreign and very, very busy. Metroplus simply does not pay enough to attract quality-​oriented doctors.
— Outdated doctor search tool. You may end up calling a lot of doctors before you find one that is actually taking your insurance.
— I was told by my doctor that providers are dropping because it takes a very long time for MetroPlus to process their claims etc. This is the main reason why I switched to a different plan for 2016.

I am highly suspicious of reviews with more than 3 stars for Metroplus! Here is why Metroplus is the worst choice for working class people (or anybody who is not dependent on public welfare):
1. LACK OF ACCOUNTABILITY
It is owned by government (City of New York). This makes it least accountable. Only phone service is available. No email. They cannot even send you plan documents, ID card etc properly. The website is a joke, because provider search is down most of the time
2. PENALTY FOR PRE-​EXISTING CONDITIONS
As a beautiful workaround for the problem of having to cover pre-​existing conditions, Metroplus and city healthcare centers colluded to create a system of excluding primary care (including preventive care) for new patients for at least 30 days. In simple terms, if you are a new patient, you cannot go to any doctor at these city healthcare centers for at least 30 days. Naturally, if you are older, there is a higher chance that you have pre-​existing diseases and the wait will be much longer than 30 days before you can get your first appointment.
3. DISCRIMINATION AGAINST IMMIGRANTS
Another beautiful workaround to deal with immigrants and poor people who live pay check to pay check is to demand upfront payment, using deductible as an excuse. This is discrimination by proxy, to punish immigrants who rely on weekly wages or payment arrangements (instalments) to meet their medical expenses. Metroplus does not tell you that initial security deposit is demanded upfront for medical care if you have a deductible. If you have a deductible of, say, $ 1000 then you normally pay the bill after you see the doctor. But in the case of Metroplus, the doctor (and Metroplus) demand upfront payment from you (upto the unmet deductible amount) BEFORE you can even see the doctor. Failing to disclose that you have an obligation to pay upfront initial Deposit or a Retainer Fee is fraud and discourages people from seeing doctor. You end up shopping around to find a PCP who charges the least security deposit
4. FAILURE TO PROVIDE PREVENTIVE CARE
Metroplus colluded with city healthcare centers to penalize working class patients by discouraging them to see the doctor for preventive care. If you call your doctor in any of these city healthcare centers for preventive or checkup, they will give you an appointment after 3 – 4 months; or until you actually fall sick. This is stupid and defeats common sense.
I bought Metroplus insurance on NY Health Exchange website. My insurance is supposed to include Dental; however, they have not given me that coverage. I also discovered that if I call doctors and tell them that I don’t have insurance, I can actually negotiate a better price to see the doctor.
The government monkeys decided that it is cute to tax ‘not having insurance’. So, we all have to buy one of the approved insurance policies to escape that tax. But I predict that, in the future, people will be paying that tax and carrying another meaningful (unapproved) insurance OR two insurance policies: one useless approved policy and the other real policy. I live in a big city (NYC) and it should not be difficult to shop around for the best price each time I need to see a doctor, without any insurance.

Good experience so far. We’ve been insured for two years (one with Gold and one with Platinum plan) and it has covered numerous visits to our primary, specialists at NYU Langone and even covered a complicated neurosurgery that required months of rest, lots of scans and MRI’s, serious meds and follow-​ups. We have found great primary care providers in our area and haven’t had any issues.
One star off because I Googled/​called/​researched online to find a Metroplus specialist because their database wasn’t fully updated. The process took a few hours but was worth the work. I found us great doctors.
TIP: DON’T GIVE UP. If you call and ask doctors before making the appointment, they will tell you if they accept Metroplus or not. Always call before scheduling a scan or surgery to check if everything including the doctors involved are covered. Make sure to test a few doctors out before settling. We went to three primary care providers before finding the perfect one for us.
Metroplus is better than the other ACA Obamacare plans if you look through the reviews for the other guys. A lot of the negative reviews are about doctors or lack thereof but if you are willing to put in the research, test doctors and ask questions beforehand, you can have a good experience. We are happy and will be renewing for the third year.

I strongly discourage anyone from going with MetroPlus if they can help it!!! As soon as enrollment time comes around again, I will see if I can afford a different insurance carrier. This is my second year with them. I would give zero stars if I could. Regarding health insurance, I’m in that category where I don’t really need a lot of coverage. My main reason for having insurance is for a catastrophic event (so that I don’t get a $ 100,000 hospital bill). So I have low monthly premiums and expect to pay more out-​of-​pocket since there’s a high deductible.
The folks who work Customer Service at MetroPlus have been consistently rude, misinformed, condescending, and careless. I record the name, date, and time of each person I speak to, but that doesn’t seem to help. No one is held accountable. They keep contradicting each other regarding coverage! My guess is that they don’t actually know what they’re talking about – I don’t think they’re deliberately misinforming me. I keep getting slammed with unexpected bills. I don’t mind paying bills but I want to know what I’m getting into when I go to a doctor or get a blood test. As I mentioned, the monthly premium I pay for my family is relatively low, so I’m guessing that the people who work at MetroPlus don’t get paid well, and their efforts and abilities reflect that. I’ve spoken to at least seven different people over the past two months and the unreliable information is consistent. I will mention that, a long time ago, there was a woman named Maggie who was polite (ultimately the information she gave me was inaccurate, but at least she was nice).
Healthcare in this country is so depressing…

MetroPlus is awful. Do not select this insurance. I’m trying to find a dentist since the one I’ve been with for 17 years does not take MetroPlus. All the options given me are no longer taking MetroPlus or reviewed very very poorly. My experience with customer service was beyond ghetto. The rep I had knew nothing about the plans. HealthPlexi, the folks who do dental, kept sending me back to MetroPlus for answers and MetroPlus said HealthPlexi should know the answer. I can’t wait to get out of this company. CAN’T WAIT.
This month they have mailed me three insurance cards all with the same info on them. Insurance cards that arrived in September that were active since Jan.

First off, everyone, please spend some time supporting your local Single Payer proponents; with your help we’ll never have to deal with health insurance again.
Second, since you still have to pay for insurance because your hard work supporting Single Payer initiatives hasn’t paid off yet, don’t get Metroplus. As many have stated, their website doesn’t have up-​to-​date provider listings, and it’s likely that your favorite doctor doesn’t take Metroplus; I’ve seen some of the worst doctors using this plan. I’m on their dental plan (through Healthplex) and since they didn’t give me a separate Healthplex card my dental office receptionists have to do a ton more work to figure out who’s paying my bills. Their prescription appeals program won’t support your doctor when they prescribe something that’s not in Metroplus’s formulary for whatever condition you have, and just like their dental coverage, their prescription program is actually subcontracted out to another provider (CVS Caremark) who you of course have to spend even more time on the phone with.
However, I never had a terribly bad time with customer service. Yay?

I don’t even know where to start how much I dislike this company!
1. I called them to change my address, they told me to call the exchange. I did everything I“m supposed to and they send my bill to my house but everything else to the old place. This is causing 10 phone calls a day asking where do I really live (I though after one that should be enough)
2. I have a really really bad back. I am pretty young but scoliosis is killing me and my lets and back are always in pain. They have denied my doctors claim to get me an MRI. So basically until they approve it I can’t get treatment. What the hell are they thinking!!!
Please do yourself a favor don’t go with them just because they are a bit cheaper. You will end up paying more out of pocket. I have all sorts of bills being thrown at me.

This review is on the behalf of my dad and his experience with getting proper health care through MetroPlus It was very difficult in the beginning getting him his card and making sure that all his paperwork went through to get him coverage but that had to do more with social services we had to go through to get him coverage. Once we filled out the online forms and mailed back his application everything came in a timely fashion. Since he needed care for a bad foot infection before he had coverage we luckily chose a facility that also happened to accept MetroPlus.
To be honest a lot of the problems we ran into with finding specialists and honest doctors tor the plethora of issues he has were eliminated once we used the website. For instance his PCP referred him to a cardiologist and on the first visit told my father that he «qualified» and needs a pacemaker. We live in Queens and the doctors referred him to a cardiologists in Brooklyn. Most places he visited seemed like they required a minimum of a 2 hour wait time, however this has nothing to do with the insurance itself and it has a system in place to report practices taking advantage of patients or not treating them properly.
Once we were directed to the website to take it upon ourselves to find a specialist we were able to find something walking distance from our house and happened to provide general care and all the other specialists that my father needs. Since he has full Medicaid he doesn’t have to pay any bills online but to speak to another review all insurance providers require you need the original bill and invoice number to pay them, otherwise how would they know which bill you are paying towards? I agree some of the facilities are horrendous, have high wait times, high turnover and Metroplus has a system in place to report that to the provider so that they shape up their facilities or face getting kicked out as a provider and risk loosing patients.

Just terrible customer service all around.
There is no online portal and you cannot pay the bill without having the paper bill in hand since you need the invoice number to pay online. That was a problem when I was travelling.
The customer service was basically useless when I called them about potential costs. Just gave me incorrect information altogether and they are trained to say «I will just take down your information.»
But even with all that I thought it was a relatively cheap way to meet my insurance mandate.
But then January 1^st, 2015 rolled around. They rolled me over to the new S2. I was not surprised to find higher (much higher in some cases) deductibles, copays, and premiums.
But they rolled me to a new PCP without explanation (they just sent me a new card with new PCP) although my old PCP was still in the network.
Every time I’ve had to use their service, it’s been a nightmare. The only reason I am still with MetroPlus is I am healthy and don’t need a lot of care.
I will be moving onto a different plan as soon as I am legally allowed to.

I really wish Metroplus had worked out for me. Every customer service representative I has spoken with (Scarlet, & Cleopatra to name two) was very helpful, and compassionate.
My reason for leaving this plan was the lack of flexibility in care.
The plan is based around appointments at your PCP for pretty much everything.
I much prefer to see my PCP for check ups and serious illnesses, and supplementing that care with visits to walk in/​urgent care facilities.
Unfortunately they work with an extremely limited number of urgent care facilities around the 5 boroughs, none of which are near where I live.
I also found the Metroplus website to be near useless. You cannot create a user profile, nor can you shop around for, or choose your PCP, or any other doctor. In order to do so you must call.
The search tools on the website are misleading as well. I had looked up a doctor, only to find out that they do not provide the care that I needed after I arrived for my appointment.
All in all, they are one of the exchange plans you might want to avoid.

If you are reading this because you are doing research for deciding on a health plan,
congratulations! You are way smarter than me!
I signed up for Obamacare last winter and waited until the last minute to look into my choices. Metroplus seemed like a great plan and was significantly cheaper than Oxford, Aetna, or other well known companies, so I signed up.
What I have found is:
that their customer service is pretty awful
Their provider network is very limited, and when you do find someone who takes Metroplus the length of time to get an appointment is a ⁵⁰⁄₅₀ that you will still be alive to make it, even if you have nothing urgent.
The two doctors I have seen have both been horrible experiences.
You will end up in horrible waiting rooms for hours. I guess Metroplus is just a step up from medicaid as far as what providers will accept, so you will be in a waiting room with all kinds of people with no insurance fighting it out to bee seen by someone because the place is way overcrowded. I made an appointment for a routine physical and was sent to a hospital where I waited for 2.5 hours, and all that happened was my doctor tried to schedule me to see a series of other doctors. They wanted to set me up for 5 separate appointments. And I walked in with no complaints, just a routine exam.
This hospital was seriously festooned with Metroplus propaganda EVERWHERE, and as I waited my 2.5 hours I was even approached by someone wanting to sign me up for Metroplus. I genuinely feel like there is some kind of billing racket going on there. Metroplus offers low rates, gets tons of money from new Obamacare subscribers, refers everyone to these ghetto hospitals that aren’t even worth dying in, set up a bunch of unneccesary appointments, and everyone makes revenue. Except for me, the patient, who took 2.5 hours out of my day to have absolutely nothing done.
. If I were on medicaid, I would deal with a long wait. I’m not. My premium is currently $ 462.69/mo and going up to $ 537.88 in the new year. For that price it is absolutely and totally inexcusable to spend 2.5 hours at an appointment in which I spent 10 minutes with a doctor who only input simple information into a program in order to tell me I should make five other appointments.
This is an eye opener to everything that is wrong with healthcare today, and you bet your sweet ass I will not be renewing with Metroplus.

Negative stars if that were an option.
Just wanted to put in my two cents, even if it’s just to echo what others have said.
NOBODY ACCEPTS METROPLUS.
If you sign up for this insurance you will find yourself on the phone for hours and days calling everyone under the sun trying to find someone that has even heard of it.
It’s all right if all you’d like is a primary care physician, but should an illness arise where a specialist is needed, you’d be out of luck. I’d say about 99.9% of the physicians listed on the Metroplus website don’t actually accept the insurance. If you call the helpline, the rep on the other end will simply pull up the exact same search engine you had been using yourself and rattle off names that you had already called. Useless.
My partner and I are paying an exorbitant amount for zero return. We chose it because of the subways ads. Go figure! Never trust subway ads.
Metroplus has taken away the last shred of faith I had in the American healthcare system. You can only get the help you need if you have the money to pay for it.