Meritain Health has been helping our members live healthier lives for nearly 40 years. Our goals include making your self-funded employee benefit plan easy to understand and use, while helping employers save on their total cost of care. As a third party administrator, we're proud to offer the flexibility and devoted service we've shared with our customers since 1983.
Today, as an independent subsidiary of Aetna and CVS, we're able to offer access to carrier-level nationwide networks, discounts and other valuable resources. Coupled with our in-house products and valued vendor partners, your customized plan includes everything you need to keep your unique employee population healthy.
Today, as an independent subsidiary of Aetna and CVS, we're able to offer access to carrier-level nationwide networks, discounts and other valuable resources. Coupled with our in-house products and valued vendor partners, your customized plan includes everything you need to keep your unique employee population healthy.
Services
We offer our strength, experience and key resources-for happy, healthy members and clients who stick around. After her son sustained a life-threatening injury, Lydia worked with a Meritain Health client advocate and the Case Management Program for air transport to save his life. Meritain Health negotiated savings that made his care more affordable for the family.
Together, we can address your population's greatest concerns, improve their health and well-being, and help you save money. We're happy to show you how. After all, your work culture starts with the people in it, right? Having unidentified or unmanaged conditions within your population can be costly-and stressful.
At Meritain Health, we'll help you champion your wellness journey through customized plan designs. And we'll help you keep an ever-watchful eye on spending, to lower your overall costs. The right tools and resources let you lend the right health guidance and support to your employees and members. Careful review of your claims and bills while maximizing discounts puts more money in your pocket.
Your population has unique needs, and we understand that. We offer streamlined solutions for administering medical, dental, vision, spending accounts, pharmacy, COBRA. We help you move beyond a "one-size-fits-most" plan design. And we know that healthier employees can lower your bottom line-we help you get there by emphasizing the right benefits and programs.
Pharmacy coverage makes any health care plan complete. And Meritain Health Pharmacy Solutions, or MPS, adds significant value to our benefit plans. We leverage our relationships with CVS Health and Aetna, and combine it with our ability as a TPA to fully customize your pharmacy plan designs.
With the CARE Program, we strive to offer detailed attention and expertise, helping our customers maximize their drug coverage for the best possible health outcomes.Rx Smart Savings encourages generic usage-supporting good health and lowering your total cost of care.
With the CARE Program, we strive to offer detailed attention and expertise, helping our customers maximize their drug coverage for the best possible health outcomes.Rx Smart Savings encourages generic usage-supporting good health and lowering your total cost of care.
Reviews (20)
Maritza G.
Oct 26, 2021
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Sujith K.
Sep 10, 2021
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Stay clear of this company for FSA and HSA accounts. One of the worst companies to deal with. They make you go through hoops to file claims and only to deny them at the end. Filed a claim for single invoice and was denied and asked to break it up into multiple claims. What does it matter? it is a single invoice and I made a single payment to the doctor. Then on another claim, the service was rendered last year and I signed up this year and got the invoice from the doctor this year and they denied it saying that it is outside of the plan year. Filed a claim on behalf on my son and they denied
Patty O.
May 27, 2021
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A. K.
Apr 10, 2021
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Meritain is the administrator for Aetna that my company provides as an insurance. As an extra layer in already expensive healthcare infrastructure, they are supposed to be extra effective in handling claims.
In conjunction with my recent medical claims, they have sent me a letter which I had to return certifying that I didn't not have any other coverage. If I were to fail to send the response on time, my claim would not be paid, they said in the letter.
The problem is, the letter had my address wrong. I have a long address, and Meritain's printing system had cut off part of the address
In conjunction with my recent medical claims, they have sent me a letter which I had to return certifying that I didn't not have any other coverage. If I were to fail to send the response on time, my claim would not be paid, they said in the letter.
The problem is, the letter had my address wrong. I have a long address, and Meritain's printing system had cut off part of the address
William M.
Apr 05, 2021
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You need to check to see if Meritain handles their claims... If you use National General (under Aetna) they do. The problem with Meritain is they will initially approve treatment until you max out your yearly amount (in my case $10,000) after that they will require an audit of your entire medical history and if they see anything related to whatever your situation is (in my case, bladder cancer) they will consider it a pre-existing condition and they will NOT cover it. Not. One. Bit. We have a lawsuit pending on this case but it won't help me now.
Nygm
Feb 01, 2021
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This is the worst insurance company I ever dealt with. Received multiple forms for a single ER claim. They claim that they never received any of the forms that I mailed to them. Ask to speak to a manager and they'll refuse you. I made multiple calls to get ID cards for my plan starting in January. I received not one but 4 mailings with cards between January 7 and Feb 7!
This is a bad company - do not use!
This is a bad company - do not use!
Jesse I.
Jan 10, 2021
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It's difficult to say is this is a good company or not. After coverage for prescription medications was denied without explanation, and despite receiving prior authorization we have not been able to reach a live human being on the phone tree to assist us. Over the last week we have spent more than 3 hours trying to get this issue resolved. Despite this we've only been able to talk to a live human for about 5 minutes and they were not nearly as helpful as I would have liked.
D. L.
Dec 23, 2020
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This is absolutely THE WORST insurance company ever. HORRIBLE. I would never recommend this company to anyone. They mailed claims to wrong address, we're trying to retrieve a large amount of $ and have been given the run around like I never imaged possible. I want to get a lawyer involved. I am currently on hold for the second time today. First time, was on for 20 min. they hung up on us. now waiting for 45 min. and still no resolution.
At wits end.
At wits end.
Lizbeth C.
Dec 15, 2020
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Have been denying a claim for the birth of my daughter for over a year now. The provider has sent multiple.claims, with all changes requested by Meritain and it's still being denied for payment. Now the provider is billing me directly due to the lack of payment from Meritain. Not worth paying over $1,000+/mo. for this terrible plan.
Felicia V.
Jun 23, 2020
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This is the worst insurance company I have ever dealt with! All the other negative reviews on here are true!! When you call them, they say they will call you back and take care of a bill and never do! They are scammers and I cannot believe they are still in business. They need to be investigated! As soon as my contract ends with them, I'm going back to another insurance company!! STAY AWAY FROM MERITAIN!!! Scammers!!!!!
Charli M.
May 01, 2020
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Absolutely worse insurance ever. Was told that I had to call within 30 days of having my baby to let them know...even though she was going to be getting put on her dads insurance. I called a couple weeks after her birth and they changed my plan to the family plan starting on the date of her birth, doubling my deductible and negating the fact that my individual deductible was already met. I ended up having to pay an additional $1,500 from my labor and delivery. It's amazing how double-dipping for insurance companies is not illegal. This is the second issue as well. The first time they did not
Marina P.
Apr 10, 2020
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My child General Pediatrician that is IN NETWORK is being proceeded as OUT OF NETWORK...I spent numerous hours on the phone and it seem nobody listened nor took a note of the occuring issue. Next bill came, they processed the claim as out of network.. :(
We have been charged by hospitals for something that the insurance should have covered in full, like my child's or my husband's ER visit.
For the previous situation that arrose a year ago,when an IN NETWORK hospital emergency they tried to charge us in full and then, when that didn't work, they proceeded as out of network and we
We have been charged by hospitals for something that the insurance should have covered in full, like my child's or my husband's ER visit.
For the previous situation that arrose a year ago,when an IN NETWORK hospital emergency they tried to charge us in full and then, when that didn't work, they proceeded as out of network and we
Danielle S.
Dec 16, 2019
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Before reading this update, I recommend reading my first (original) review. In the first review you'll find helpful tips and info about how Meritain *really* operates. Here's the update...
1) A Meritain rep (mentioned in my first review) violated HIPAA privacy rules when corresponding with me -- she cc'd my employer on an email that I thought would be private. It contained private health details like names of providers and the type of services I got. It sure seemed like retaliation when she did it. She said she cc'd my employer because she saw herself mentioned in my first
1) A Meritain rep (mentioned in my first review) violated HIPAA privacy rules when corresponding with me -- she cc'd my employer on an email that I thought would be private. It contained private health details like names of providers and the type of services I got. It sure seemed like retaliation when she did it. She said she cc'd my employer because she saw herself mentioned in my first
Jack W.
Jul 22, 2019
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A terrible company that makes you jump through hoops and even in my case (a very healthy active adult) claims everything is pre-existing - even where its not - not even CLOSE. This year, i rolled my ankle in sports, but since 12 months prior I was treated for plantar fascia, (same foot) they considered it "pre-existing". LOL. This is the second year I have had them. Then they make you jump through hoops to claim otherwise - clearly to make it as difficult as possible.
There is a bigger issue here. We as an American society need to come together to write our legislators and
There is a bigger issue here. We as an American society need to come together to write our legislators and
Elena S.
May 03, 2019
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This insurance is not for the faint-hearted, meaning you need to be persistent, consistent, and keep communication going.
It's a lot of work. My son had a surgery and the claim was denied, but after a few calls and conversations the claim was eventually reprocessed and paid. I was happy. I don't know if it's because I was patient and nice enough? Or just luck? Not sure. The deductible was fulfilled and they are paying for all his PT visits which is also very helpful.
I'll see how it goes for another half a year before making a decision.
It's a lot of work. My son had a surgery and the claim was denied, but after a few calls and conversations the claim was eventually reprocessed and paid. I was happy. I don't know if it's because I was patient and nice enough? Or just luck? Not sure. The deductible was fulfilled and they are paying for all his PT visits which is also very helpful.
I'll see how it goes for another half a year before making a decision.
Sandra B.
Jan 10, 2019
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Horrible horrible horrible experience
I am a behavioral health provider. I billed this insurance company for eight sessions at $120 per session. Their data entry person (at their end) incorrectly entered $1.20. They refuse to correct it. They stalled stalled stalled and refuse to correct it. My client finally left this insurance company and now they really refuse to pay so I'm out of the money?
I'll take them to small claims, and also plan to call my state representative to report this "out of Integrity" insurance company
I am a behavioral health provider. I billed this insurance company for eight sessions at $120 per session. Their data entry person (at their end) incorrectly entered $1.20. They refuse to correct it. They stalled stalled stalled and refuse to correct it. My client finally left this insurance company and now they really refuse to pay so I'm out of the money?
I'll take them to small claims, and also plan to call my state representative to report this "out of Integrity" insurance company
Bill Wright
Jun 10, 2018
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Meryl Trahant
Nov 20, 2017
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Vickey Pennick
Nov 10, 2015
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FormerEmployee Chaz
Jun 05, 2014
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Company is good for a starter position. Most people spend 2 years and jump ship to market competitors. Company is on the lower end of the spectrum for wage increases. 1-4% at the staff level so don't have high expectations there. The company is generous with their PTO and they're pretty flexible with work schedules. Company is doing well but will most likely be absorbed into the parent company in the coming years. Managers are 50/50 most will do what is necessary to get ahead and will toss anyone under the bus to avoid getting taking responsibility for their actions. Some people in the company
