Consumer Alert: SHPS Inc. aka Carewise Health.com Catch-22

carewisehealth.com

carewisehealth.com

Many companies troll the web looking for consumer comments on themselves — SHPS/Carewise Health.com ought to read this, as should any company thinking of contracting with them for HCRA sevices.  (Everyone else can skip this — UC no longer contracts with them, and for good reason. HOWEVER, it would help get SHPS‘ attention if people link to this.  You don’t have to read it, just link.  Let’s use the power of the web.)

  • I paid my optometrist’s bill using the SHPS/HCRA debit card
  • SHPS came back declaring a portion of the bill ineligible. They did not say which charges, and there is no single charge or combo of charges that adds up to that amount.
  • They notified me that I had until March 17 to appeal this.
  • I sent them a copy of  the itemized bill from my optometrist — reasonably enough, I figured they just needed to see the charges.  And besides, I didn’t know what part of it they were disputing, so what else could I do?
  • They turned it down again.
  • I called to ask what was turned down and why- -how they came to that total –   and they could not tell me.  The amount was inelgible, but they themselves don’t know what or why.
  • And now they say I didn’t appeal by the deadline — because what I sent (by the deadline) was turned down.

How can they turn down a charge when they themselves don’t know what they were turning down, let alone why?

And everyone I call there  stonewalls me. I’m now working through UC’s benefits office on this, but please link to this post and to SHPS and help me get the word out about their crappy company.

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51 responses to “Consumer Alert: SHPS Inc. aka Carewise Health.com Catch-22

  1. Hi Nancy,

    I am having the very same problem with SHPS.

    I paid a dental bill with the SHPS spending card for dental fees. They never informed me anything was wrong until I looked on-line. I called them and they told me I had to send them an itemized receipt. Again they did not notify me that it would not be accepted. I called again and I was told I didn’t check the right box so I resubmitted for the third time. I just checked on-line and I see that it is in the ineligible column without explanation.

    Second issue:
    I received a letter from UCOP in March 09 that I owed the university $2.90 for unsubstantiated charges to my SHPS account for 2007. Again, I was never notified by SHPS that this was outstanding. SHP’s online system did not reflect this amount. I wrote to SHPS with UCOP’S letter stating that I believed this to be in error. I included the final paperwork and receipts for year ending 2007 that I did receive from them to substantiate $5.95 stating that this was all I had received from them for 2007. Their answer: was to completely ignore my request for correction or documentation for $2.90, and the paperwork I provided for $5.95 was no longer acceptable as it has passed the deadline.

    I am too being stonewalled. I now plan to notify my benefits office. I hope more people will post to your blog.

  2. SHPS employee

    Well… I work for SHPS. While I have Humana insurance my FSA is managed by SHPS and it is a pain. I routinely get requests for receipts for a good many claims. This wouldn’t be so bad in and of itself but they keep requesting the same receipts over and over and over. It has been a never ending ordeal. They have denied a few small claims, a few dollars, which I paid just out of frustration. If I were an employer I would not submit my employees to the problems that come with SHPS/HCRA.

  3. My husband has lymphoma, and the SHPS group has repeatedly refused to accept EOB for charges to his health care spending card. He has stopped using the card, since it is more trouble to dispute claims than to pay deductibles up front.

    Right now, we are in dispute over a charge that is just over a thousand dollars, and SHPS did not even acknowledge further claims sent via snail mail. I sent a package the size of a small novel, with every EOB printed out, and they have not paid any claims, and they continue to demand documentation or reimbursement for these “ineligible” claims.

    At the rate this is going, there will be over three thousand dollars in profit for SHPS, because they are hanging onto the money and not paying any claims.

  4. WELSH, CARSON, ANDERSON, STOWE/SHPS CANCELS MEDICAL BENEFITS OF A 60+ TEACHER, WITH A PERFECT 22-MONTH PAYMENT HISTORY, BECAUSE TEACHER FORGOT TO CHECK THE BOX.

    I SENT ERIC SPEECE, SHPS ADMINISTRATOR A FAX COPY OF THE VERIFY PAYMENT FORM INDICATING THAT I HAD THOUGHT THAT I MADE THE PAYMENT. MR. SPEECE REFUSED TO ACCEPT THE FAX AS MY EFFORTS TO MAKE THE PAYMENT.

    I HAVE WRITTEN RECORD FROM SHPS THAT I HAD ONCE PAID THEM 6 MONTHS IN ADVANCE.

    WHY WOULD I INPUT THE BANK DATA, HAVE THE MONEY IN THE ACCOUNT AND NOT PAY THEM?

    SHPS, INC HAS A FAULTY WEBSITE DESIGN WHICH MISLEADS THE USER INTO BELIEVING THAT THE PAYMENT HAS BEEN MADE.

    MOST WEBSITES IMMEDIATELY NOTIFY THE USER THAT THE INFORMATION IS NOT COMPLETE.

    PLEASE FORWARD THIS BLOG TO WELSH, CARSON, ANDERSON, AND STOWE , THE OWNERS OF SHPS, INC. THE OWNERS ADDRESS IS 320 Park Avenue, New York, NY 10022, (212) 893-9575.

    I THOUGHT THE VERIFY PAYMENT FORM VERIFIED THAT I HAD MADE THE PAYMENT.

    SHPS CANCELLED MY BENEFITS FOR NON-PAYMENT AND WILL NOT LET ME REINSTATE.

  5. Russell Richardson

    Yep, just like my experiences. This is essential fraud and could be actionable under FTC rules.
    I think they count on no one taking the time.

  6. I submitted an orthodontics claim of $30 and $22 was marked as ineligible. I called SHPS and asked why, they told me because I did not submit an itemized receipt. I immediately sent them my orthodontics contract which indicated a monthly payment plan, the $30 was not specific to a service date therefore no itemized receipt was available. I waited for days and called again. SHPS said that $22 was ineligible because I had an ineligible claim 5 months ago, it had nothing to do with my orthodontics claim. I asked which claim they were referring to, and immediately sent over the itemized receipt (including hospital patient account receipt and EOB from insurance) for that claim they specified from 5 months ago. Then I waited for over a week. I emailed and called, heard nothing. Today I still have that $22 marked as ineligible expense on my account. I asked to get a hold of their supervisor, no one got back with me. These people are unbelievable.

  7. Over due for a Class action lawsuit. My company dropped them after 2 years. There were so many complaints. I’m sure there are thousands of consumers burnt by this company out there.

  8. I too hate Carewise/Shps. They are the most unprofessional people to deal with very nasty first of all. They do not want to hear anything. They have not approved my PT after 20 visits for TKR
    I had complications and need more visits which my PT place sent in for approval they claim they never got it so now I am not able to go until they (not even doctors) decide if I can go or not. I will be letting my HR dept know my company is waisting their money with this service. They stink

  9. I am writing because I googled to see if there were any other complaints about this company. I am livid because they are telling me that my expenses are ineligible. Even better…A. They waited until July to tell me expenses from last year are not eligible. So, that means if they are ineligible then I cannot access the money now. Also, it was for chiropractic care and says so in BIG letters. I know my chiro care was eligble. I even called to clarify with the company and mine. This was before I knew there was a list and I was new to all of this. I am livid. I will send in my proof. That the clearly marked chiropractic care was really chiropractic care. Uggghhhhh! My company switched this year. Thank goodness. They are no longer using this company.

  10. SHPS are also the people behind FSAFEDS the Flexible Spending Plan for federal employees. Same scams except instead having a card they make us fill out forms and fax them. But they routinely deny very legitimate expenses. These people are liars, thieves and cheats and should be in jail.

  11. MH – I’m having the same experience regarding chiropractic care. They continue to deny my claim, even after I’ve submitted all the information they requested. They told me, “We don’t know what kind of treatment you received there.” Really? It’s a chiropractor. Do they think I went there to buy a new purse or to get my taxes done?

  12. After a number of calls, I was successful in wringing a reimbursement from SHPS last year.

    I had my phone on speaker, with a recorder running, when the customer no service person got tired enough to acknowledge that I was correct. I probably spent three or four hours before that happened, however.

    If there is a dispute, the best advice I can offer is to call them, repeatedly, and be very stubborn.

    As for my household, we cut back the amount of money in the “flex account” even though we were sure to spend much more.

    I have kept things extraordinarily simple. Instead of sending reams of insurance EOBs, I just sent in dental claims, and single visit, larger expenses, such as a medical test.

    Maybe the problem with SHPS is as much stupidity as fraud.

  13. Oh, really. Give me a break. with the card check out Irs validation Ruling 403-43.. its 9 pages, that tell you why your card swipe has not been validated. Grow up people. This post wont stay out here, cause its true. And mr Fed employee.. maybe you are not sending the correct documenation. all forfitted funds go back to the EMPLOYER.

    • The main problem that I have had is that the SHPS customer service can’t explain what “further documentation” they need after I already sent them 8 pages of itemizated bills from my optometrist or why they are denying the claim in the first place. It took 5 months and multiple calls to find out why they refused to pay for my new crown. This behaviour on the part of SHPS does make them seem exceedingly shady.

  14. Maxine -
    The money “left over” in your FSA does, indeed, stay with your company / EMPLOYER. According to the IRS. But do you really think we (the subscribers / contributors to FSA’s) are stupid enough to believe that SHPS is not paid on that basis?? I will never again use the “FSA” option, as SHPS has managed to (and is still actively engaged in) stealing my contributions for some of the most rediculous reasons I have ever heard. And oh, BTW – If you (SHPS) cannot “find” all of that ‘supporting documentation’ I sent in, such as EOB’s and Itemized Statements – I think we have a serious HIPPA issue going on here… What the hell are you all doing with my “personal information”??? I have fax confirmations of 10+ pages of documentation sent in (per claim) where SHPS says they “never got that”… So, where the hell is it my dear??

  15. Exec VP Human Resources

    I have received a tremendous amount of complaints in 2011 concerning SHPS not documenting ineligibility codes, refusal to state what parts of a larger claim have been determined to be ineligible, and like issues. I asked my team to research this and decided to Google it this morning. It seems that this has been a problem for over two years, across multiple customers.

    We will be looking closely at SHPS’ competitors for our 2012 plan. I expect a tremendous amount of complaints for the 2013 plan year due to ObamaCare’s reduction of the maximum Flex Spending account to $2,500. I certainly hope that it is overturned by the new and improved Congress.

  16. at&t retiree Karen

    I just checked my SHPS HRA account to check on the status of my 2010 medical claims. I have $2000 available to use and submitted $2650 ( just to be safe, in case any of my claims were denied) in all valid medical , dental and vision expenses. All my claims were denied as ineligible with either code G6, E3, or K1! They do not provide a key to advise what the codes mean. I found this site while searching the internet to see if I could find a key to the codes. This is my first year using SHPS as a retiree with a HRA account. I am shocked. I have had FSAs serviced by SHPS for over 20 years while employed with at&t. I have successfully submitted claim forms & received reimbursement with few problems over the last 2 decades. What is going on!. Why would they not provide a key to the codes?? I will be calling them first thing in the morning. Its already so time consuming to get all the EOBs and receipts together and then to have the claims denied. And this is a benefit?! Atleast make it usable!

  17. I am so frustrated with SHPS! I have called them and provided them with the exact paperwork that they request and then they still manage to find some error with it. When I told the woman on the phone that I went over what I was sending to them the last time I called, all she would say is I’m sorry you were misinformed. Every time I submit a claim, they find reasons not to pay it. Their online details are confusing and inadequate in explanations of why charges are not being paid. I will never work with them again…….it seems they just try to keep your money. Consumers should watch out for this company!

  18. SHPS is a dirty dirty company. If you want to deal with a company that is reasonable and friendly, and has common sense….this is not the one for you. If you want poor service, a denial on every claim…even one for a pap smear…(apparently the ppl at SHPS are so dumb they think that it is likely that I am using my tax free funds at the DOCTOR for something non medical)…, and a company with zero morals, conscience and common sense…then this is the company for you!! Congrats SHPS, you have found a way to rob people legally of their hard earned money!

  19. Shady isn’t the word for SHPS – aka “Carewise health”. They are blatant liars. They continually deny receiving medical info from our doctor when we stood there in his office and watched them fax it with confirmation. That is so they can retain their URAC rating. They are liars and theives and need to be investigated by the OAG office – AGAIN!

  20. Two more great reviews. I couldn’t agree more.

    http://www.yellowpages.com/louisville-ky/mip/shps-fulfillment-5406173?lid=157942948

    SHPS does nothing but robs people of their money and their health. They are what is wrong with healthcare in America today.

  21. SHPS is a den of thieves. Never again will I contribute my money to a flexible spending account. Somebody needs to investigate this operation

  22. Hey…glad you wrote the blog you did…was looking for a job as an RN in the insurance industry….you def have shown me one company that I want NO part of….good luck…take care….Terry…joiboi67@gmail.com

  23. foxed@fastmail.fm

    The program is funded by forfeited money at the end of the year, so it is in their best interest to deny claims… and they seem to do it for arbitrary reasons to make the process more difficult. My latest incident with them is beyond frustrating.

    I had to build a wheelchair ramp at my home for my daughter. I did the work myself to save money, but kept very detailed records of materials, photos of construction, etc. I got the letter of medical necessity, bundled all the paperwork, and sent it off. The claim was for about $1,200.

    Two weeks later, I got a response telling me that I would have to complete a “Capital Expense Worksheet.” You have to complete one of these for improvements that might increase the value of your home. However, a wheelchair ramp is listed as an expense that does not increase the value of your home by the IRS (the basis for the Capital Expense policy – see the FSA web site) and no such paperwork is necessary. Other improvements such as adding handicapped bars in the bathroom do not increase the value of your home and do not require the before/after valuation. However, the SHPS/FSAFEDS policies arbitrarily require this form to be completed.

    The kicker is that they REQUIRE a professional appraisal of your home BEFORE and AFTER the capital expense. In my area, that would be between $700 and $800 worth of appraisals just to file the expense. When discussing it on the phone with their agents, I presented the scenario where I would add a $100 worth of handrails in the bathroom – in order to claim $100, I have to spend $800 in appraisals?????? For my wheelchair ramp, the cost would go from $1,200 to $2,000. Furthermore, the agent from SHPS told me that the appraisal cost was NOT reimbursable!! I have to spend $800 to file a claim out of my own pocket.

    To add to the injury, the Capital Expense Worksheet calculation requires that you divide the cost of the project by the number of people living in the home to determine how much you can claim. Huh???? I spent $1,200 to build a wheelchair ramp for my daughter, but can only claim $300 because there are four people living in my home????? If this is the case, I have to pay $800 in appraisals to file a $300 claim on a $1,200 expense??? Again, an arbitrary rule to make it more difficult and to try to keep my money.

    The last time I had to file a claim for a bidet to assist my daughter in the bathroom, I had to file the paperwork seven times because each time they found something they didn’t like – sometimes conflicting with what they said the previous time it was filed. I had to go to her pediatrician four times to have the Letter of Medical Necessity (LMN) reworded and signed again. The last time was because on the letter it asked for a duration of treatment and he wrote “lifelong” because her condition is permanent. They rejected it again because they say the length of treatment is limited to a year. Ugh! Fortunately, the doctor waived his fee for completing such paperwork – if he hadn’t, I would have had to spend $100 on the LMNs.

    In my opinion, these people are bordering on crooked. They clearly have incentive to make claims difficult and are trying to keep money you are legitimately entitled to.

    At this point, I’m heading to the doctor to get prescriptions for several OTC items – a year’s worth of Claritin, blood pressure monitors, vitamins, etc… I’ll spend the $1,200 on stuff I might need.

    • Hi I had a very very similar experience. What can be done to get these people in court or at least have OPM cancel there contract.

      I got so far as to get to an independent Arbitor (whom they didn’t identify or allow me to communicate with)

      This is absurd.

  24. Lets see… One for Carewise- Ninty-nine against. My experience has been the same. My son is getting braces. We started the process in 2009. Every single claim I’ve submitted has been denied. Not enough details on the work done, No valid medical category on the itemized bill, need the Dr.s signature on the itemized bill, No active account during services, on and on. I called and argued with a supervisor and now Every claim is denied. I changed employers and the keep denying my claims due to no active account. I call and say I changed employers when I log into you web site it shows both accounts for 2011. The aknowledge it and then deny for the same reason. They denied over 600 dollars I paid out of pocket for medications because “no active account” while I was in transition between companies. Yet I put the money aside for the 2011 calendar year. If its for the calendar year of 2011 then why’s the expense not covered. Because you didn’t have an active account for the month of October 2011. Then what’s the money I put into the account during November and december 2011? On that’s for the calendar year 2011. Then whys my claim denied. Because you didn’t have and account in October 2011. OK so the funds I put in are only for nov & dec 2011? Oh no… There for the calendar year 2011……

    Arrrrrgggggg!!!! My question is plain and simple. Who pays Carewise/SHPS fees for services? Because that’s who they really work for. It’s sure not in my best interest. The money goes back into the fund? Ok so are the allowed to invest that money because that would explain why the deny everything. This really is a scam and there’s more the meets the eye going on. The friggin IRS isn’t even this picky about receipts and documentation.

  25. I can only pass on what I’ve been told… SHPS is funded by forfeited funds at the end of the year. That implies that they get paid to deny claims.

    To me, the biggest frustration is the brick wall of stupidity that you get when you deal with the SHPS customer service people. They have been trained to read back to you whatever they see on their computer screen. If you get “escalated” to a supervisor, they read the exact same information back to you that the first line of customer service told you. I can quote to them the IRS regulation that contradicts their arbitrary policies, but they do not care. “We are making minimum wage… here’s what we’ve been told to say….”

    I found someone at OPM to whine to. I don’t know if it will do any good as I am in the hands of yet another bureaucrat who promises oversight of this program that seems out of control.

  26. My husband went to the DR and got a script for Zyrtec which is an eligible OTC medication. We bought the Zyrtec out of pocket and submitted a claim form and they denied the claim stating we were supposed to take the script to the pharmacy and get the pharmacist to fill the OTC med and give it an RX number in order to be reimbursed. the IRS guidlines clearly state you only need to do that if you want your claim substantiated at the point of sale so you can use your debit card. You dont need to do that if you are submitting a manual claim. But i spoke with 3 people today including a manager who keep reciting that is the way SHPS interprets the rules. My daughter uses an otc acne med that i buy via the web. I asked them how I could fill that and they told me I couldn’t. I told them they are wrong and they guy actually called the pharmacy and tried to get them to take my opened zyrtec back and rering it with an rx number. These people are ridiculous. I plan to take this all the way to my companies management and the dept of labor, my elected officials, my state agencies. i will get a friggen lawyer if i have to.the picked the wrong woman to mess with. Oh and the Better business bureau has 34 complaints about them…

  27. I work for Defense and had got a contact at OPM back in 2007 b/c they wouldn’t anser the phone. I believe their contract with OPM was pretty new back then. The situation was straightened out and I had no problems until around 2010 I noticed them getting more stringent. I sent this email to that contact but I ‘m not sure she is still there since it’s been a few years.

    “They are turning down my receipts for physical therapy even though I sent a copy of the prescription for it and at one time that was enough. Now they
    want a letter of medical necessity. I also see a doctor who is not in my
    insurance so I pay cash or credit card. They will not reimburse me the
    $70.00 office visits. The Dr. Office will not put down why I’m being seen
    because of privacy laws. I thought as long as you had a receipt from an
    M.D. Dr. office or Prescription for what is needed they would pay and over
    the years it has become more difficult.” BTW I was under the impression that NO OTC meds were covered this year due to Obama’s new rule that you must get a prescription first. I don’t even try doing OTC stuff since I’m lucky to get reimbursed on stuff I have a prescription for. I have a knee brace (arthritis) and owe $185.00. God knows what they’d do if I submit that. I guess I better get that letter of necessity and prescription from the same doctor who they won’t reimburse the visits I pay cash for. Geez.

  28. Wow, I wish I had never tried FSAFEDS. Last year I thought I’d give it a small try and signed up for something like $300. As the year progressed and I had some dental work done, they seemed to reimburse it okay. I finally got a message sometime around June 2011 telling me my benefits had run out…okay, fine….this morning I got an e-mail telling me that I owe them $174 due to some Audit. That’s it. Just an e-mail, no details no attachment; WTF? How can a company that got $300 from me and that’s it, go over that? Where is their accouting system? Then I try to call and it’s a 20 minute wait. I’m sending them a letter and want to cc someone but don’t know who. I saw above that I can complain to the FTC and I will. We all need to! But who else is our advocate???

  29. I knew I wasn’t the only one having problems with FSAFEDS. I’m switching to my employer’s plan (not SHPS) just to avoid dealing with FSAFEDS any further. Let’s see…a bill from a doctor’s office for a “co-pay” is rejected because the bill doesn’t detail the kind of medical service performed? Why else would I go to a doctor’s office and pay them something? A bill from an orthodontist’s office is rejected for the same reason…so the office administrator was kind enough to redo it and sign it for me. She said she received similar complaints from her other FSAFEDS patients. My doctor not only has to write a prescription for medicine that she used to prescribe me before it became OTC, but she also has to write a letter of medical necessity. Um, why would I take it if I didn’t need it? Why isn’t the prescription enough? Oh, and if it’s not your account, but your spouse’s, you need a HIPAA form to discuss your child’s dependent care expenses. The HIPAA form authorizes the disclosure of “confidential medical information.” Since when does that mean disclosure of why your dependent care receipt has been rejected? “Well, SHPS/FSAFEDs interprets it that way.” On what authority? Certainly not HIPAA. I have had numerous claims rejected, only to resubmit them exactly the same way and have them approved. I can say that I have gotten all of my money back, but it’s such a tedious process that I’d rather not be bothered. Do these SHPS employees realize that if there are fewer contributions, they will eventually be out of a job? I think the administration is giving them a kickback for discouraging people from legitimately saving on their taxes.

  30. When FSAFEDS works, it works great. I dropped off a prescription at my local pharmacy recently and within three days I got the reimbursement notice. Way to go, SHPS.

    It’s when you have anything out of the ordinary… anything that they can deny and make you work… sometimes very, very hard… to get your money back. I posted the story previously about my wheelchair ramp. The only reason I got reimbursed without ridiculous out-of-pocket expenses is because I found a local home appraiser who was kind to me and provided a letter without charge for SHPS saying that the ugly ramp in front of my house did not increase the value of my home. Without such kindness, SHPS told me that I would need $800 worth of appraisals to file a $1,200 claim. To be more accurate, the SHPS supervisor told me that I would need the same $800 worth of appraisals to file a $100 hypothetical claim for bathroom handicapped access bars.

    My most recent frustration with SHPS says a lot about how they treat claims. Remember, these people make their money on forfeited claims, so it is in their best interest to deny anything they can and make you fight for your claims.

    My daughter recently received a service dog to help her with her disabilities. Routine care for a service dog is an eligible expense. When we first brought the dog home, I had to buy a few hundred dollars worth of stuff for him (crate, training treats, medications, food, etc.). According to the “eligible expenses jukebox,” all of these items are reimbursable for a service animal. Expecting a problem, I sent in an excess of documentation. I sent his service dog certification. I sent scans of all the products, receipts, UPC codes, and an explanation of how they were applicable for a service dog. I sent a letter from his trainer as to how he could help my daughter. I sent a medical necessity form from the doctor. I even sent a copy of his diploma when he graduated “service dog” school. They sent me the “claim received” notice and within a couple hours the “claim rejected” notice. I am confident I spent about four times as much time filing the claim as they did reviewing it.

    Here I go again… another call to SHPS. Ten to fifteen minutes on hold and I got to talk to a person. She was very nice. She put me on hold for another ten to fifteen minutes so she could talk with her supervisor. When she came back, she commented that I had done an excellent job supporting the claim and didn’t know why they had rejected it. A nice outcome, but another example of how they make it difficult to file obviously legitimate claims. Why couldn’t the first line of claims processing given me the same outcome? It is as though they have trained them to automatically reject anything but a “normal” claim. It is pure harassment and clearly a shakedown so SHPS can profit from forfeited claims.

    BTW – I have contacted the Inspector General at OPM. I would recommend that everyone else do the same. If you feel harassed and that you are spending way too much time fighting for legitimate, obvious claims, tell the IG of the fraud that SHPS is engaged in for their own profits. They are governed by IRS regulations for a FSA and they ignore these regulations every single day in the interest of profits.

  31. I just maxed out my FSAFEDS account and I am dancing with joy. Last year things went relatively soothly and I was able to budget a reasonable amount of money for the year and claim it back.

    This year I did the same. However, after the enrollment period ended, FSAFEDS notified all their participants that they were changing their requirements for submitting claims. So beware, you agree to the terms at the begining of the year and you are locked it, but they can change those rules whenever they wish and you can’t opt out.

    I had a recurring monthly doctor bill that began rolling over month to month and I wound up with six months worth of recurring claims bunching over and over. I had to pester my doctor with form after form to get back each $30 co-pay.

    They aren’t playing by the rules. I will not recommend SHPS or FSAFEDS to anyone in the future.

  32. who “I found someone at OPM to whine to.”

  33. SHPS is so bad that we’re going to drop our daycare flex spending and pay more in taxes just to avoid using them. After 10 years, we just can’t take it anymore.

  34. I don’t even know where to begin…what a nightmare this company has been over the past year. I need a L3, L4, L5 Lumbar fusion and not only have they denied pain management injections, they denied a scheduled surgery 4 days before I was to have it…their rationale: “I still had some stability in my spine; therefore, physical therapy would probably be a better option.” Since when does an insurance company give out medical advice over a specialized physician. I could go on and on and on, and in the meantime, I am using all of my sick leave for an operation I did not have, and have had to pay for all of my own medical needs. They remind me of the film The Rainmaker, hopefully I won’t die before they pay…terrible, terrible company. I am in the process of hiring an attorney to help me regain my medical costs and sue them for pain and unnecessary suffering and I have NEVER sued anyone in my entire life…anyone want to join in a class action?

    • I’m in for a class action law suit. I have been trying to get lumbar blocks for months to help with the massive amount of pain I am in and keep jumping through hoops and never get anywhere. Please let me know who you all are filing complaints with. Thanks Katie

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  36. Similar experience to the rest. SHPS really started getting ridiculous about 3 years ago. Not sure what changed in their contract. Has to be some sort of incentive. No real problems before that. My latest experience was on a orthodontic claim which I have been sending in for years (4 kids). After denying it and instructing me to send in a clearer receipt.they denied it again when I complied and required me to send in the contract – as if it were a fraudulent claim. OPM manages the contract so I complained to them instead of dealing with the internal coverup at SHPS HR/customer service. I recommend you all do the same. Keep these posts going. .

    • Steve we share a similar story…see below they also asked me for a copy of the contract and my loan agreement. I’ve provided them with my daughter’s orthodontal contract with each and every reimbursement I ever sent to them and still denied my claim. And from speaking with a Claims Supervisor they did change contracts sometime in 2011. Still has no bearing…
      Do like I did…contact OPM’s Inspector General’s Office as well as contact your State Senator. In speaking with my Senator’s office they are aware of the problems with SHPS/CareWise and they are looking into it for me.

  37. They denied all 6 prescription claims that I faxed over with receipts. When I called and inquired why, the person first put me on hold and when she finally returned, she said it shouldn’t have been denied and would resubmit the claim. I just got a notice today that 5 of them were submitted and 1 was arbitrailiy left off. Uh-huh. And I love how they cover themselves. The code they used was R1- This claim was previously denied but was reprocessed as outlined above based on additional information.
    There was NO additional information….excepted I called and ask why a legitmate claim was denied. I’ll be calling again and most likely ….again.

  38. I’ve had the same experience with FSAFEDS…I’ve been a member of FSAFEDS since 2011 and have NEVER had a claim denied. The majority of my claims have been to cover the monthly payments for my daugher’s braces (which is a covered expense). Well in Jan. 2013 FSAFEDS decided to deny my claim for reimbursement and they wanted to see a copy of my loan agreement. I informed them that my monthly payments are NOT a loan and have never been a loan for the past 2 years. They claimed they denied the reimbursement because my claims for reimbursements have increased. When I provided them with documentation that my payments ARE NOT a loan but to GE Capital/Care Credit they still refused to pay. They have given every excuse not to pay…and one benefits counselor even had the audicity to claim that “FSAFEDS has paid more than enough towards my daughters braces expense and I should’ve paid the amount off years ago.” o_0

    I’ve filed appeals after appeal after appeal…which they have denied, but will not contact me personally to verify information.

    Enough was enough…I filed a claim with OPM’s Inspector Generals Office for fraud/waste and abuse and that is when I FINALLY heard from a Claims Supervisor. Claims supervisor. The claims supervisor was not any better…these people are stuck on stupid and parked on dumb.

    I took it a step further and I contacted 2 of my State Senators and asked them to look into it. They are and I spoke with a constituent representative today and they are aware of the issues with SHPS/CareWise.

    I say all of this to URGE, BEG and PLEAD with you all to do what I did. 1) File a fraud/waste and abuse claim with OPM an 2) contact your State Senators. We are federal employee’s and this is OUR MONEY…if more we band together we can prevent this from continuing and get some restitution. THERE IS STRENGTH IN NUMBERS!!!!

    Contact OPM’s Inspector General (just go to opm.gov and select Inspector General – you can file you claim online). Then search for your State Senator on line and contact their consituent services office. DO IT TODAY…DON’T WAIT!!!

  39. Just to let you know that my contact at OPM indicated that SHPS should never ask you for the contract. A SHPS manager contacted me and apologized personally.

  40. FSAFEDS that is.

  41. I didn’t think they could ask me for a copy of a contract…and therefore I never provided them with any. I was actually able to get in contact with someone at OPM who works with the administration of the FSAFEDS account and explained to him what has been going on. He was shocked and he is now looking into it (especially after I explained the various excuses I received from the FSAFEDS benefit counselors).

    I also received a call from my state Senator’s office…they are in contact with OPM as well as FSAFEDS to find out exactly what is the holdup with my reimbursement. Keeping my fingers crossed!!!

  42. So FSAfeds is ADP now not SHPS as is the entire benefits buisness they used to own. Carewise just runs programs for health and wellness counseling. So screaming about Carewise or SHPS is kinda silly. Gripe about ADP.

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