Allegiance Benefit Plan Management, Inc.

In response to this complaint, we have to amend our previous answer. Her employer terminated the services of Allegiance as of 10/31/2014. We processed run-out claims for them until 1/31/at which time the run-out service ended as well. Once our contract with a self funded group ends, all authority to provide any claims services or information for that group also ends. We are not able to reconsider this claim. She has the option of notifying the employer of the situation so they can consider reimbursement

Allegiance Benefit Plan Management (Allegiance) provides third party administration services to employer sponsored, self-funded health benefit plansThe benefit plan Complainant participates in is not insurance but rather a self-funded benefit plan governed by ERISAFurthermore, Allegiance is not the insurer of the plan.
All claims for benefits, such as those described by the Complainant, are processed according to the terms of the self-funded plan's plan documentIf Complainant believes the claims were not processed correctly, Complainant's remedy is to file an appeal as explained in the plan's plan document. Complainant states that he did not know this. The appeal rights are printed on every explanation of benefits that goes out on processed claims, which the complainant would have received on the claims he is questioning. The plan's appeals provisions include two levels of appeal. If Complainant should disagree with the outcome of the First Level Appeal, Complainant will have the opportunity to file a Second Level Appeal to the Appeals Committee of the Claims Manager. If Complainant needs additional information on filing an appeal, Complainant may contact Allegiance's customer service number at ***. As previously mentioned, due to federal privacy requirements, no health claim information can be provided absent receipt of a signed, HIPAA compliant authorizationThank you

Allegiance legal department send the following notice to the plan participant via US mail:
This is in reference to your letter concerning the above-referenced consumer inquiryAllegiance Benefit Plan Management, Incis not an insurerRather, Allegiance provides third party administration
services to employer sponsored group health benefit plans. Due to federal privacy requirements, no additional information can be provided to you at this time absent receipt of a HIPAA-compliant Authorization completed by the individual to whom the information pertains. Additionally, all of the plans Allegiance provides services to contain appeals provisions allowing plan members to appeal any claims they believe were not processed and paid correctly. The consumer in this instance needs to utilize the appeals provisions of the plan in order to pursue an appropriate remedy. Thank you

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution is satisfactory to me
Sincerely,
*** ***

I had no idea when they quit processing the claimsI am so beyond mad because I sent in the claim within a month of my appointment and they lost itI think them denying to pay me is horribleLike I said before I should have sent it in certified because then they couldn't lie about recieving itAs I said before, if they had come across a bill I owed them they would not hesitate to demand the money regardless of any cut off dateFor *** at Revdex.com to allow them to deny paying me is also horribleReally??? So if I received a bill from them because I owed them money and if it had been after a cut off date it would be okay for me to not pay it??? It's not like it's years afterIt's within a year after a cut off date their office has given themselvesI'm sure there is a manager there that could okay thisI am now filing with the Department of InsuranveI think them not paying this is a shame when I have proof.
Revdex.com,I have reviewed the response made by the business in reference to complaint ID *** and have determined that this does not resolve my complaintFor your reference, details of the offer I reviewed appear below.Regards,*** ***

Revdex.com,I have reviewed the response made by the business in reference to complaint ID *** and have determined that this does not resolve my complaintFor your reference, details of the offer I reviewed appear below.**Please See Attached**Regards,*** ***
This letter is response to the business and their response to meI did file the paperwork and receipt in the month following the date of receipts when I got my glasses considering the money came out of my pocket firstIt is not my fault your office lost the original receiptThis is why I now only have the pink receipt because the original white receipt was sent in to your officeHindsight maybe I should have sent the paperwork in certified so someone would have to sign for it since your saying you never received itYou should do the right thing and pay me the money that is due to me under the contractual obligation you had with the employee's of *** *** *** ***Under the contract we are to pay out of pocket for the glasses and you will in turn reimburse us up to $once you received the proof of receiptAgain I mailed in the original receipt but your office lost it and therefore did not mail me the money that is due to meIt's not like I am trying to get yall to reimburse me twiceYou never reimbursed me so I am asking for my moneyIt's money that is due to me that I paid out of pocket for a pair of glasses with the understanding you would reimburse me
Again, I am asking that you do the right thing and pay the money that is due to me for the glasses I paid for out of pocketWith the prices of insurance, medications and doctor visits one needs all the money they can get reimbursed to themYou know as well as I do that if you came across a payment I owed you and it was a couple of months after a cut off date that yall have, you would still want me to pay youThat is all I am asking from youPlease pay me what is owed to me for money I spent out of pocket because of your contract with the employees of *** *** *** *** that has us pay first and you reimburse us

This is in response to the complaint submitted by *** ***. We did receive a claim from the optometrist for the exam, it was sent without an assignment of benefits which means we pay the member rather than the providerHowever, we did not receive a reimbursement request for the
eyeglasses. With the date of service being 8/14/2014, she is past the timely filing deadline. It would have had to been filed by 8/14/

We recently found out that Revdex.com emails were being caught in our spam filters so this is the first time we have seen this complaint. Our apologiesIt was not our intent to ignore thisWe take complaints very seriously. Revdex.com is now whitelisted and this should not happen
again. I have forwarded this information to the appropriate parties at Allegiance so they can review and will respond as soon as possible

As of 9:24 am today, Thursday, February 23, 2017, this has been resolved and the card has been reactivated and is available for use.  We received the documentation on 2/16/17 and our normal turnaround time is five business days to process the information.  The original statement received...

for documentation did not contain the necessary information.  In the action required information sent we had asked for either a statement or an EOB. We are looking into whether or not we can change the system notice to be more clear for better guidance on what we need so there will be no further delays.  The EOB that the claimant submitted had everything necessary and we were able to substantiate the charge and unlock the debit card.  Our sincere apologies for the delay which was one day outside of our normal turnaround time.  We receive a large volume of claims and documentation for substantiation this time of year due to plan runout. Again, our apologies and thank you for reporting this.

Complaint: [redacted]I am rejecting this response because: the Allegiance rejects to talk about the dispute under the name of privacy protection.  I called the insurer and was told they act upon Allegiance's instruction. Allegiance did not follow the insurance police and overscharged me on my daughter's medical cost and it is doing it again to my wife. I called Allegiance three times, their representatives were rude, rejected my inquiry under the name of Privacy protection. I am the person who purchased the insurance policy. all bills come to me. I have the right to know how the police was followed. Allegiance never told me how I should appeal. and it has the burden to explain why it lied to me and our medical service provider. if allegiance needs a permission from patients it should let me know. please let me know who the governmental organization that has the power correct Allegiance. Sincerely,[redacted]

this is the same message I read a week earlier. seems like they don't want to do anything else. again, I don't accept Allegiance's answer. Allegiance intend to put more burden on me as I indicated in my initial complain. they rejected my telephone inquiry saying they can't provide patients' medical info to me. but they sent all patients' medical info to me via their"explanatory letters" already. on those letters there were patients' personal infos and laboratory results. seems they don't realize that  they broke the patients's privacy already. ironically they told me they can't broke patients' privacy over our phone conversation. whenever I called, their agents said we can't discuss with you due to patients' privacy limit. I was quickly rejected on demanding a explain on our dispute. so I need help to deal with them. if Revdex.com can't do anything please tell me which governmental orgnization monitor them. I will ask help from there. anyone would know Allegiance is a trouble maker simply by listening to their answermachine message. the message will tell you they are ready to give you hardtime no matter what it is. whatever, I need instruction on how to fight with them. 
Complaint: [redacted]I am rejecting this response because:Sincerely,[redacted]