Clearwaterhealth Avis 7

**Title: Months of claim problems, portal failures, inconsistent explanations, and no real accountability**

My experience with ClearShare / Clearwater Benefits was a disaster.

This was not one isolated claim issue. In my records, this became a repeated pattern across more than 25 claims involving confusing portal statuses, inconsistent explanations, provider resubmissions, appeal delays, and claims being marked as denied, duplicate, paid, accepted, missing information, in process, or requiring more documentation.

I was sold ClearShare / Clearwater as part of a healthcare package that also included add-ons such as HospitalWise, AccidentWise, Term Life, and Cancer Insurance. What I experienced afterward was nothing like a reliable healthcare solution.

Examples from my records include:

* Preventive care showing $0 benefit issues.
* PCP / office visit claims being handled inconsistently.
* Multiple 99214 office visit claims treated differently, including dates such as 12/19/24, 03/19/25, 04/04/25, and 07/25/25.
* Provider records showing a 12/19/24 claim for $346.22 unpaid, a 03/19/25 claim for $257.60 unpaid, and a 04/04/25 claim for $257.60 where only $64.40 was paid.
* A Quest / lab-related bill from 03/19/25 for $876.32 that was initially misrouted and later had to be reprocessed/escalated.
* Claims I disputed including PC-000238865 for $257.65, PC-000140276 for $549.48, and PC-000232581 for $876.32.
* Appeal #00037822 being upheld even though I continued to dispute the underlying handling, portal problems, and claim logic.
* Cases being merged or closed while the actual problems remained unresolved.
* A portal that repeatedly required uploads, lacked clear submission tracking, rejected or closed duplicate receipts, and created an administrative nightmare.
* Broken appeal/document upload issues.
* Providers being told to resubmit, while I was told information was missing or that the provider had not done what was needed.

I also requested plan documents, member guidelines, adjudication criteria, duplicate-claim logic, and internal policies for the ClearShare 2500 / Holistic Premium plan because the processing did not make sense to me.

I cancelled after becoming completely dissatisfied. I requested cancellation and removal of ACH authorization, and Clearwater later confirmed the plan cancelled effective June 30, 2025. Even the cancellation process became another dispute because of the 30-day cancellation policy and no-refund/no-proration approach.

I filed or pursued complaints with multiple agencies, including the Florida Attorney General, Florida DFS, BBB, FTC, and other regulatory channels. My Florida DFS complaint was CAS-07441-T4Y8P6, filed January 21, 2026. Unfortunately, I received no meaningful help that actually solved the underlying claims or billing problems.

Consumers need to understand this before enrolling: ClearShare’s own materials say it is not insurance and that members remain personally responsible for their medical bills. That is not a minor technicality. In my experience, it became the entire problem.

I strongly urge anyone considering ClearShare, Clearwater Benefits, or any related healthshare product to read the public regulatory actions first. Washington regulators fined ClearShare / Clearwater-related entities for unauthorized health insurance activity, and Oregon regulators issued a cease-and-desist order after determining the program was operating as insurance without proper authority.

Based on my experience, I would never recommend ClearShare or Clearwater Benefits to a family looking for dependable medical bill protection. In my opinion, the process felt designed to delay, confuse, deny, shift responsibility, and leave the consumer stuck with the bills.

This is the absolute worst insurance that has ever existed. It has been nothing but problems for every single claim. All providers say they have never experienced how horrible this health insurance is, ever!! They try to cheat us on everything that is supposed to be paid. They make us and the provider call over and over and over! DO NOT USE this crook of an insurance company! Save yourself time, money, and a headache!

This is the biggest fraudulent scam I’ve ever seen when it comes to people who advertise themselves like insurance, but do nothing but take your money and not reimburse providers. Just like below. I’ve had the same experience as where they. They lie and imply that they are paying. They give every provider the runaround of not making the payment and then they lie to us saying that providers were missing information or they didn’t receive it or they didn’t submit it in time. 100% regret ever giving these people a dime. Now I’m getting collection letters. Make sure to look up the Washington state lawsuit where this company was brought into legal action and find because they did not pay and we’re acting like an insurance. They took in over $500,000 and paid out only something like 57,000.

They are very quick to collect your premium but are not very good at paying claims. Have claims outstanding for 9 months and no follow through by claims or customer service. Physician's office had the same experience trying to give the claims department what they are requesting but every time they call, they get a different answer or they can't explain the information that they are looking for to process the claim....Stay away!!!

The worst experience I have ever had with a health insurance company. These idiots discontinued my policy but they continued to bill me after the policy was terminated(by them!). Then they refused to cover claims that occurred during the policy period. They would take 4 or 5 months to issue payment for covered medical visits. Worst company ever. Zero stars

Absolutely awful! After being highly dissatisfied with our so called coverage, trying to cancel our membership is an even bigger nightmare! Do not get involved with these scammers! The doctors listed as being in network have no idea what Clearwater is, same with the Urgent Care facilities listed as “in network”.

If it were possible to rate below one star, I would. My experience with this company has been extremely disappointing from start to finish. I have since returned to my HMO and could not be more relieved to be done with this process.

As a new member, I was referred to a covered physician who ordered X-rays at the same facility immediately following my appointment. Three months later (December 2024), I discovered that while the physician was covered, the X-ray procedure was not—simply because it was performed in that facility.

Since then, I’ve spent eleven months trying to resolve this claim with Clearwater. Despite making at least 21 documented calls in the past six months—and likely as many before that—I’ve made no progress. Each interaction has been repetitive and frustrating:
1. “Send us the invoice information.”
2. “Send the billing address, NPI number, and payer details—we’ll notify you once it’s processed.”
3. “It’s been too long; you’ll need to start over.”

This cycle has gone nowhere.

From my experience, Medishare plans appear to operate without meaningful oversight, allowing them to avoid accountability. Coverage issues were frequent, but the lack of customer support was worse. After countless hours on this issue with no resolution, I deeply regret ever enrolling. I would have preferred to pay the expense upfront rather than lose so much time and energy dealing with such an unresponsive system.