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Administrative Concepts, Incorporated

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Administrative Concepts, Incorporated Reviews (35)

From: Revdex.com of Metro Washington DCDate: Mon, Jan 5, at 11:AMSubject: Fwd: Revdex.com Consumer Complaint ID [redacted] To: [redacted] < [redacted] @myRevdex.com.org> ---------- Forwarded message ----------From: Jon P [redacted] < [redacted] @visit-aci.com>Date: Mon, Jan 5, at 11:AMSubject: Revdex.com Consumer Complaint ID [redacted] To: "[email protected]" [redacted] , We have issued payments in regards to the complaint submitted by [redacted] (***) on 12/29/as follows: Claim [redacted] -we paid $7,on 12/29/14, check # [redacted] to [redacted] ***Claim [redacted] -we paid $on 12/29/14, check # [redacted] to [redacted] Claim [redacted] -we paid $on 12/29/14, check # [redacted] to [redacted] ***Total payment of $8, We consider this matter resolved from our perspective Please let us know if [redacted] has anything she sees as unresolved Thank you, Jon P [redacted] Vice President - Claims & Operations Administrative Concepts, IncOld Eagle School Road, Suite Wayne, PA 19087-www.visit-aci.com Phone ###-###-#### Fax ###-###-####

[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the responseIf no reason is received your complaint will be closed Administratively Resolved] Complaint: [redacted] I am rejecting this response because:I will not accept the offer until the issue is resolvedThe business has been saying that they are waiting for these records for the past year, even though the records have been sent to them multiple times via mail and faxI feel like they are dragging their feet in the matter and will accept their offer once I am contacted with a resolution in this matter Regards, [redacted] (***)

From: Revdex.com of Metro Washington DCDate: Mon, Jan 5, at 11:AMSubject: Fwd: Revdex.com Consumer Complaint ID [redacted] To: [redacted] < [redacted] @myRevdex.com.org>---------- Forwarded message ----------From: Jon P [redacted] < [redacted] @visit-aci.com>Date: Mon, Jan 5, at 11:AMSubject: Revdex.com Consumer Complaint ID [redacted] To: "[email protected]" [redacted] , We have issued payments in regards to the complaint submitted by [redacted] (***) on 12/29/as follows: Claim [redacted] -we paid $7,on 12/29/14, check # [redacted] to [redacted] ***.Claim [redacted] -we paid $on 12/29/14, check # [redacted] to [redacted] Claim [redacted] -we paid $on 12/29/14, check # [redacted] to [redacted] ***.Total payment of $8,We consider this matter resolved from our perspective Please let us know if [redacted] has anything she sees as unresolved Thank you, Jon P [redacted] Vice President - Claims & OperationsAdministrative Concepts, IncOld Eagle School Road, Suite 1005Wayne, PA 19087-1802www.visit-aci.comPhone ###-###-####Fax ###-###-####

[A default letter is provided here which indicates your acceptance of the business's response If you wish, you may update it before sending it.] Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution is satisfactory to me Regards, [redacted]

December 10, 2014We are in receipt of the correspondence from the RevDex.com (BBB) dated 12/01/14. Administrative Concepts, Inc. is a Third Party Administrator contracted to administrate claims on behalf of [redacted] of Insurance Companies/Federal Insurance Company for the policy... offered to [redacted] Educational Foundation participants. [redacted] (son of the Complainant), as a member of [redacted] Educational Foundation, is insured under Policy Number [redacted] from 08/01/13 through 07/31/14.This letter is in response to your correspondence regarding concerns on file # [redacted] submitted by the Complainant named above. The Complainant, [redacted] ***, is writing regarding unpaid medical expenses submitted to our office for treatment rendered to her son, [redacted] ***, on 11/15/13 totaling $8,437.50 in payments made by [redacted] ***.We have reviewed the concerns and issues noted by [redacted] regarding the expenses totaling $30,502.60, for which she paid $7,537.50 to the provider out of pocket and is seeking reimbursement. Upon review of the documentation provided, we are issuing payment totaling $7,537.50 to [redacted] for these expenses.Please be advised that, in order to process the $900 payment receipt submitted by [redacted] for the anesthesia services on 11/15/13, a copy of the billing and [redacted] of CA Explanation of Benefits statement are needed. Upon receipt, we will review and process accordingly.If the member has any questions or concerns regarding claims or policy benefits, she may contact our office for assistance.Please let us know if you have any questions or require any additional information. Thank you.Sincerely,Jennifer PClaims Supervisor

Administrative Concepts, Inc(ACI) is a Third Party Administrator contracted to administrate claims on behalf of [redacted] Insurance Company for the policy offered to [redacted] Guaranteed Association participants ACI does not sell and does not collect premium for the [redacted] Guaranteed policy The member would need to contact [redacted] , where they purchased the plan to request resolution of their complaintSincerely, Jon P [redacted] Chief Operating Officer

We are in receipt of the correspondence from the Revdex.com (Revdex.com) dated 1/21/Administrative Concepts, Incis a Third Party Administrator contracted to administrate claims on behalf of BCS Insurance Company for the policy offered to Norfolk State University participantsOriel Rena [redacted] as a member of Norfolk State University, was insured under Policy Number [redacted] from 08/01/through 07/31/13.This letter is in response to your correspondence regarding concerns on file # [redacted] submitted by the Complainant named aboveThe Complainant, Oriel Rena Rivers, is writing regarding unpaid medical expenses submitted to our office for treatment rendered on 12/16/totaling $4,187.37.We have reviewed the concerns and issues noted by MsRiversUpon review of the documentation on file, we are missing an Explanation of Benefits from her primary carrier to resolve this claimThe plan Ms [redacted] is enrolled under is an Excess plan and contains the following statement:If a Covered Person has other insurance, benefits under this plan will be paid on the unpaid balance after the other insurance has paidNo benefits are payable for any expense incurred for Accident or Sickness which is paid or payable by other valid and collectible insuranceThis Plan will cover unpaid balances, deductibles and other eligible expenses not covered by other insuranceBenefits will be adjusted so that the total amount paid or payable under two insurance policies combined does not exceed 100% of the expenses which are incurred.We sent a request to the insured for the Explanation of Benefits from the Primary Carrier on 3/13/and again on 4/10/We have not received a response to those requests.Based on what is described in the complaint, there appears to be a misunderstanding in regards to the type of policy the insured is enrolled inAlthough enrollment was mandatory for Norfolk University Students for the Accident plan, the plan was not a Primary policy and included the above statement indicating the policy will pay after other insurance has paidThere is no provision in the policy for the plan to act as primary dependent upon the location of a particular accidentAs a result, the fact that the incident occurred on school grounds is not relevant to the determination of which insurance plan would act as primary coverage.In the complaint it is also indicated that ACI submitted the claim to Optima to obtain a denial or approvalThis action was not taken by ACI and ACI is not responsible for the submission of claims to another carrierOn 3/27/13, an ACI Customer Service Representative received a call from Ms [redacted] and our representative indicated we needed Explanation of Benefits from the primary carrier and requested the member to submit the information.At this time, this claim remains pended for the Explanation of Benefits from the primary carrier, which the member would need to supply to our office.If the member has any questions or concerns regarding claims or policy benefits, she may contact our office for assistance.Please let us know if you have any questions or require any additional informationThank you.Sincerely,

Good morning,The policy under which the complainant is insured contains a pre-existing exclusion for any condition which manifested prior to the effective date of the policy We are attempting to obtain medical records to rule out the possibility of the condition manifesting prior to the effective date of the policy We have contacted the facility and have paid for records to be expeditiously delivered to our office today Upon receipt today, we will be reviewing the records and making a claim determination for this case We have communicated with the member via phone advising them of our actions to obtain the records We will update the member upon receipt of the records today Please let me know if there should be any questions Thank you,Jon P [redacted] Vice President - Claims & OperationsACI

We have contacted the complainant and have issued claim payments on the claim that had been questioned All bills which were presented as outstanding are being paid on this claim ACI has fully resolved the claim and presented issue at this time.Thank youJon P [redacted] Vice President - Claims & Operations

Administrative Concepts, Inc(ACI) does not have any involvement or authority in the sale or collection of premium for the *** *** program and was not involved with selling the insurance to you. ACI is a Third Party Administrator assigned to process the medical claims for the
*** *** plan. Please contact *** *** *** at *** for resolution to the issue you have presented. Thank you, Jon P***

+1

Good afternoon,Administrative Co Incpts, (ACI) does not have any involvement or authority in the sale or collection of premium for the *** *** ** *** (***) program. ACI is a Third Party Administrator assigned to process the medical claims for the *** plan. Please
contact Group Plan Administrators at *** for resolution to the issue you have presented. Thank you

Complaint: ***
I am rejecting this response because:I am rejecting Administrative Concepts Incresponse because my husband died as a result of his fall that led to complications which resulted in his death Administrative Concepts is trying to get out of paying the claim because it would result in them paying out $20, for the Accidental Death which they DO NOT want to do and have succeeded in giving me the runaround againThey have not even acknowledged his hospital stay of one month at $a day after his fall! This company is the biggest scam that does not provide the service that you sign up for and will do anything to get out of paying your claim How are they still in business? TERRIBLE!
Regards,
*** ***

Please see the attached response to the complaint submitted on 1/21/15. Please feel free to contact me if there are any questions

*** *** was covered 7/27/through 8/26/and we received claims during that time. We received one claim for a medical office visit, which was paid $per the policy schedule of benefits. Two claims were received related to covered wellness services and we paid the $
wellness benefit on the first claim and denied the remaining services as over maximum number of visits for wellness per the policy limitations.Administrative Concepts, Incdoes not sell nor collect premium for the *** *** *** insurance plan. If *** *** would like to discuss how the product was presented to her in the sale of the policy, she should contact the *** *** *** at ###-###-####.Attached is the certificate for the *** *** *** plan. Thank you

***Thank you for reaching out and expressing your experience We apologize for the difficulty you have had in reaching us Our Customer Service Manager has attempted to contact you by phone and has sent you an email to contact him directly by email or phone at your earliest convenience
to discuss the claim for one of your patients. Additionally, we do offer online claim status for providers There is an application process where you are assigned a User Name and Password to securely access your patient's claim information If interested, you may go to our website, www.visit-aci.com and select the Provider Login button at the top of the site You may obtain an application for Claim Status there. Thank you,Jon P***
*** * ***

Good morning,
The policy under which the complainant is insured contains a pre-existing exclusion for any condition which manifested prior to the effective date of the policy. We are attempting to obtain medical records to rule out the possibility of the condition manifesting prior to
the effective date of the policy. We have contacted the facility and have paid for records to be expeditiously delivered to our office today. Upon receipt today, we will be reviewing the records and making a claim determination for this case. We have communicated with the member via phone advising them of our actions to obtain the records. We will update the member upon receipt of the records today. Please let me know if there should be any questions. Thank you,
Jon P***
Vice President - Claims & Operations
ACI

[A default letter is provided here which indicates your acceptance of the business's response.  If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me. 
Regards,
[redacted]

Administrative Concepts, Inc. (ACI) is a Third Party Administrator contracted to administrate claims on behalf of [redacted] Insurance Company for the policy offered to [redacted] Guaranteed Association participants.  ACI does not sell and does not collect premium for the [redacted] Guaranteed...

policy.  The member would need to contact [redacted], where they purchased the plan to request resolution of their complaint. Sincerely, Jon P[redacted]  Chief Operating Officer

Good morning,The policy under which the complainant is insured contains a pre-existing exclusion for any condition which manifested prior to the effective date of the policy.  We are attempting to obtain medical records to rule out the possibility of the condition manifesting prior to the...

effective date of the policy.  We have contacted the facility and have paid for records to be expeditiously delivered to our office today.  Upon receipt today, we will be reviewing the records and making a claim determination for this case.  We have communicated with the member via phone advising them of our actions to obtain the records.  We will update the member upon receipt of the records today.  Please let me know if there should be any questions.  Thank you,Jon P[redacted]Vice President - Claims & OperationsACI

December 10, 2014We are in receipt of the correspondence from the Revdex.com (Revdex.com) dated 12/01/14. Administrative Concepts, Inc. is a Third Party Administrator contracted to administrate claims on behalf of [redacted] of Insurance Companies/Federal Insurance Company for the...

policy offered to [redacted] Educational Foundation participants. [redacted] (son of the Complainant), as a member of [redacted] Educational Foundation, is insured under Policy Number [redacted] from 08/01/13 through 07/31/14.This letter is in response to your correspondence regarding concerns on file # [redacted] submitted by the Complainant named above. The Complainant, [redacted], is writing regarding unpaid medical expenses submitted to our office for treatment rendered to her son, [redacted], on 11/15/13 totaling $8,437.50 in payments made by [redacted].We have reviewed the concerns and issues noted by [redacted] regarding the expenses totaling $30,502.60, for which she paid $7,537.50 to the provider out of pocket and is seeking reimbursement. Upon review of the documentation provided, we are issuing payment totaling $7,537.50 to [redacted] for these expenses.Please be advised that, in order to process the $900 payment receipt submitted by [redacted] for the anesthesia services on 11/15/13, a copy of the billing and [redacted] of CA Explanation of Benefits statement are needed. Upon receipt, we will review and process accordingly.If the member has any questions or concerns regarding claims or policy benefits, she may contact our office for assistance.Please let us know if you have any questions or require any additional information. Thank you.Sincerely,Jennifer PClaims Supervisor

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Description: Hospitalization, Medical & Surgical Plans, Insurance Claim Processing Services, Insurance Consultants, Insurance Services, Insurance Services - Commercial

Address: 994 Old Eagle School Rd Ste 1005, Wayne, Pennsylvania, United States, 19087-1802

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