★★★★☆
I wish I could give this horrible company 0 stars, but at least I can warn others. We were enrolled by America First Healthcare (broker) with promises of wonderful maternity coverage. We signed up for a high monthly premium for a $0 OOP maternity care plan (or so they claimed). After we signed up and began to pay, Clearwater then stated that they could not negotiate a “deal” with the hospital, and that the costs would now go towards our 5k deductible. As disappointing as that was, multiple people assured us that 5K would be the MAX OOP cost (I have multiple emails/correspondences proving this). They proceeded to get a letter of agreement with the hospital to bill them as in network, once again assuring that I would have no issues. Then several denied claims followed. I reached out about this and was connected to a manager to deal with the issue. I was assured that my claims were denied due to a “billing issue”, and then got the first 4-5 denied claims reversed and applied towards our deductible (indicating and directly reporting back the issue being resolved). Several more denied claims then appeared (they are VERY slow to process claims -intentional). I then reached out about these not getting corrected, and it took the company over a month to get back to me. They responded saying that the manager working with me and that there was a new manager, Donicia Z, that would help me. I was then told that they would work on my case but in the meantime I needed to file detailed appeals for every single denied claim (this took HOURS). Clearshare was consistently extremely slow with their responses (days/weeks). To shorten a long, grueling process for the sake of this review, once the baby was born, they stated that NO MATERNITY CARE would be covered, claiming that this was a “policy change” that happened during my pregnancy that I “should not be receiving hospital based maternity care”. I explained to management and to the appeals team that I live in a rural part of the country in regards to healthcare, the other closest maternity care to me is 3 hours away, and still hospital based. Despite the OB practicing within a hospital setting, it was all outpatient and billed as such (as most OBs are set up this way). Also, we were never notified of any “policy change” during this time period. They did not care about any of this. After 3 rounds of appeals, attaching all my emails proving the LOA, my correspondence with management “ensuring” coverage, medical necessity documentation, and proof of no other medical care options for mother or baby, they continued to deny all maternity care. They have left my family with medical bills as if we had no insurance coverage whatsoever during maternal fetal care (THOUSANDS of dollars), despite the high premiums we paid to them the entire pregnancy. We would have been better off having no insurance coverage. On top of this, they also denied emergent diagnostics required for other family members AFTER providing us with a preapproval letter for the specific diagnostic, with documentation of medical necessity, requiring these to also be paid completely OOP with no deductible application. This company is nothing short of fraudulent and unethical, to say the least. They will lie to you to get your business and then change whatever they want, as they are not bound to state laws being a “medical sharing community.” We caution everyone to stay as far away from them as you can!
★★★★☆
This company is a scam. Please do not put yourself through the frustration of dealing with them. They take about a year to pay claims. The providers will start billing you and advising that bills will be sent to collections which will affect your credit score. Now you can’t get past AI to talk to a human. It will take you 10 attempts to get transferred to a ringing line that will then disconnect. Be prepared to waste hours of your life dealing with them. Whatever internal systems they have are broken. I have submitted reimbursements with all necessary documents only to have them request it again because they changed their process. Eventually, time passed with no resolution because every time you call in, you start over. You speak to a new person who has no clue on previous conversations. I am disgusted that such a careless company like clearshare exists. It is a scam and you deserve better service, faster claim processing, faster reimbursement, and the ability to speak to a human being that is competent and can resolve any issues. It essentially seems as though they have outsourced their call center and have this operating with little care for members experience. They recently changed the coverage this year and I was not aware. I asked how members were notified and they mentioned an email was sent but were not able to tell me what email it came from or to resend/provide the information. This company is broken and should not exist. It is truly a scam and they are collecting members fees and providing the bare minimum.
★★★★☆
Looks like they went through a happy period bringing in and helping customers, and now they're in the period where they rake them over and make money. Old reviews are helping their over all ratings, newer reviews are bad. Leaving and reporting these guys to the State of Texas.
For those considering getting or leaving: Clearwater Benefits Administrators has 28 BBB complaints in 3 years, with 18 closed just in the last 12 months. Online forum threads outright call it a scam, with members reporting lost claim documentation, delays past the 60-day acceptance window to force denials, and pregnancy claims going 9 months unresolved. This is unfortunately a common pattern with what are called "short-term" or "limited benefit" health plans that are not ACA-compliant, they're lightly regulated and designed to minimize payouts. You're right to leave.