We have reviewed Ms*** fileIt appears we were waiting for her and recordsWe have been informed that there were no records for this time period and we are adjudicating her claims according to the terms and conditions of her policyIf I can be of further assistance, please let
me know.Respectfully, Brittani S*** Compliance Assistant ***@hcclife.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
[Provide details of why you are not satisfied with this resolution.]
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this response/resolution is satisfactory to me.
Regards,
*** ***
We have also received a complaint for this policyholder through the Kansas Department of InsuranceWe will respond through the Department of Insurance.If I can be of further assistance, please let me know.Respectfully, Lori L***ParalegalHCC Life Insurance Company317/221-8013l***@hccmis.com
As was indicated in the initial response,
HCCMIS needs medical records from Dr*** for Ms***'s claims and
medical records from Dr*** for Mr***'s claims. The documents
that were provided do not include these records. Once the medical records
have been received, HCCMIS will determine if the claims are eligible under the
policy. In regards to pdenials, the policy does not cover
conditions that began or manifest prior to the effective date of the
policy. The effective date of the policy is 6/17/at the moment the
coverage was purchased. Per the claimants statement form, the insured
experienced symptoms in the morning upon waking up. Therefore the
symptoms manifested prior to the purchase and effective date of the
policy. Consequently, the pdenials are correct
Please see the attached response to the following complaint: RE: Complainant: *** ***IN Revdex.com File #: *** Thank you, LoriDear MsPotter, We have again reviewed the file for Mr***We have not received itemized statements from any provider for an inpatient stayWe have received and paid claims related to three outpatient servicesIf claims for the inpatient stay are received within the timely filing guidelines in the policy, we will review the claim and medical records to make a determination on paymentUntil the documents are received, there is nothing additional we can do for Mr***. We have now received and responded to the Department of Insurance Complaint Mr*** has file with the State of Indiana, we are asking the Bureau to close the complaint Mr*** has filed I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll***@tmhcc.com
We have reviewed Ms***'s file and issues in her complaintUnfortunately, the services were excluded under her policyConsequently, her claims were properly denied under the terms and conditions of her policy.If I can be of further assistance, please let me know. Respectfully,Lori L***HCC
Life Insurance Company***@hccmis.com(317) 221-
HCC Medical Insurance Services (HCCMIS) reviews both the HCCMIS website and policy wording multiple times each year. HCCMIS appreciates Mr***’s feedback and will take Mr***’s feedback into consideration. If adjustments or changes are needed HCCMIS will make the changes accordingly I hope this information will allow the Bureau to conclude the handling of this file. If I can be of any further assistance, please let me know Sincerely, Jon Padgett, Vice President, Claims and Compliance HCC Medical Insurance Services
Revdex.com:I have reviewed the response made by the business in reference to complaint ID***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.The response from HCC is totally
untrueAs per HCC response I "was seen for Hypertensive chronic kidney disease, atherosclerotic heart disease headache, hypertension, cough, and hypoxemia on December 14, and December 15, 2015" is totally wrongI have attached here my hospital discharge instructions as a proofAs per my hospital discharge instructions, "you came to hospital for very high blood pressure and nausea, vomitingwe treated her high blood pressure and she improvedShe was also found to have low oxygen; we tested her lungs and she did not have a blood clotHer oxygeneation improved when we have her medications to remove the extra fluid"My old medication for my other diseases continued, which I used to take as per my Indian doctors instructionsThe only medication prescribed by doctor on 12/14/was to replace my blood pressure medication from Amlopres to AmlodipineMy blood pressure increased only because I ate somewhat high salt food in the previous nightDoctor recommeded in his discharge instruction to "eat a low salt diet"Furthermore, My hypertention (for which I saw doctor on 12/14/2015) is not chronic and not gradually becoming worseIt was under control through medicine and diet and it was undercontrol during the time I stayed in USA for another monthsI do have kidney disease but that also under control through medication and dietOn 12/14/2015, I didn't went to hospital for treatment for my kidney disease, nor any medical advice, diagnosis, care, or treatment was given for that diseaseFurthermore I don't have any atherosclerotic heart diseaseBecause of sudden high blood pressure, doctor did presecribed CT scan, Heart X-ray, and Lung scan to make sure there is no damage in any of these vital organsNote that I didn't go to doctor for problem in Heart, Lung or Brain and all my tests were normalI have test results from that date to provde thatComing to Visitor Secure plan policy, as per the benefit details in the brochure and the Vistorcoverge website (from where I took this insurance) inpatient hospitalization is coveredI have brochure to prove that and also anyone can see by him/herself at the following website: http://www.visitorscoverage.com/visitor-health-insurance/quotes/ Regards,*** ***
We apologize for the delay in processing Ms*** claimAfter reviewing Ms*** file, it is determined that her claim was properly paid under the terms and conditions of her policyhope this information will allow the Bureau to conclude the handling of this fileIf I can be of further
assistance, please let me knowRespectfully, Brittani S*** Compliance Assistant ***@hcclife.com
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.[I talked with the *** *** *** (Provider) and they confirmed that they billed the HCC insurance for $onlySo I called HCC insurance and the customer service representative said that they separated the original $into two separate bills of $and $227.Can HCC insurance please confirm whether they will reprocess both these bills?]Regards,*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below. I have been promised several times in the last 10-months by HCC medical representatives that they are re-reviewing/escalating this case, however, every time I call back to check I hear that either there is no decision made or they need to escalate again. So, I will accept the solution and close the case once the payments are actually made.Please let me know once you do that.Hope you will understand my frustration and close this case ASAP.Thank you!
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
[Provide details of why you are not satisfied with this resolution.]It has been four business days now and they have not contacted the hospital yet to try and resolve the billing issues of the overbilling.
Regards,
*** ***
Please see the attached response to the following complaint RE: Complainant: *** ***IN Revdex.com File #: ***Medical Insurance Services Group North Illinois Street, Suite 600, Indianapolis, IN, USA Tel: 317-262-Fax: 317-262-Toll Free:
800-605-2282 [email protected] hccmis.com November 3, 2016 Ms*** *** Revdex.com N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Complainant: *** *** IN Revdex.com File #: *** Dear Ms***, Mr*** *** a citizen of India purchased international travel coverage under our Atlas America Program for his travel inside the United StatesThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by Lloyds, London and Tokio Marine HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and AdministratorThe policy was active from August 24, to February 10, 2017. Mr*** was treated in the emergency room on September 3, The claims for that date of services have processed per the terms and conditions of the planAll follow up claims are pending a full set of medical records from the hospital in which Ms*** was treatedOnce received, we will continue our review of the remaining claims. I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll***@tmhcc.com
We have reviewed the issues raised in Mr*** complaintWe have determined that his claims have been properly processed under the terms and conditions of his policyIf I can be of any further assistance, please let me knowRespectfully, Charles ** *** Esq770/ 693-
***[email protected]
Please see the attached follow up in regards to the below complaint: RE: Complainant: *** ** IN Revdex.com File #: ***Dear Ms*** We have again reviewed the file for Ms**On June 28, 2016, via an appeal outcome letter, Ms** was informed that if medical records are received from the Urgent Care Center we will again review the claims on fileAt this time the medical records have not been submitted for review. I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll***@tmhcc.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Yes they DO have all of the documents "dr." Jorge Menendez has all of the items and given all of the continued rejections of my claimAs usual this company is providing any means possible for denying any claimI will spend another day at the hospital going through the corporate ** that HCCS does to avoid paymentThey have fine tuned their denial process as legal thievery sending me through the process over again to resend the paperwork that they already possessThey have done this repeatedly for othersThey are also in violation of the issuance of VISA health insurance with zero deductable
Regards,
*** ***
We have reviewed Ms*** fileIt appears we were waiting for her and recordsWe have been informed that there were no records for this time period and we are adjudicating her claims according to the terms and conditions of her policyIf I can be of further assistance, please let
me know.Respectfully, Brittani S*** Compliance Assistant ***@hcclife.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
[Provide details of why you are not satisfied with this resolution.]
Regards,
*** ***
please see the attached response to complaint #***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this response/resolution is satisfactory to me.
Regards,
*** ***
We have also received a complaint for this policyholder through the Kansas Department of InsuranceWe will respond through the Department of Insurance.If I can be of further assistance, please let me know.Respectfully, Lori L***ParalegalHCC Life Insurance Company317/221-8013l***@hccmis.com
As was indicated in the initial response,
HCCMIS needs medical records from Dr*** for Ms***'s claims and
medical records from Dr*** for Mr***'s claims. The documents
that were provided do not include these records. Once the medical records
have been received, HCCMIS will determine if the claims are eligible under the
policy. In regards to pdenials, the policy does not cover
conditions that began or manifest prior to the effective date of the
policy. The effective date of the policy is 6/17/at the moment the
coverage was purchased. Per the claimants statement form, the insured
experienced symptoms in the morning upon waking up. Therefore the
symptoms manifested prior to the purchase and effective date of the
policy. Consequently, the pdenials are correct
Please see the attached response to the following complaint: RE: Complainant: *** ***IN Revdex.com File #: *** Thank you, LoriDear MsPotter, We have again reviewed the file for Mr***We have not received itemized statements from any provider for an inpatient stayWe have received and paid claims related to three outpatient servicesIf claims for the inpatient stay are received within the timely filing guidelines in the policy, we will review the claim and medical records to make a determination on paymentUntil the documents are received, there is nothing additional we can do for Mr***. We have now received and responded to the Department of Insurance Complaint Mr*** has file with the State of Indiana, we are asking the Bureau to close the complaint Mr*** has filed I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll***@tmhcc.com
We have reviewed Ms***'s file and issues in her complaintUnfortunately, the services were excluded under her policyConsequently, her claims were properly denied under the terms and conditions of her policy.If I can be of further assistance, please let me know. Respectfully,Lori L***HCC
Life Insurance Company***@hccmis.com(317) 221-
HCC Medical Insurance Services (HCCMIS) reviews both the HCCMIS website and policy wording multiple times each year. HCCMIS appreciates Mr***’s feedback and will take Mr***’s feedback into consideration. If adjustments or changes are needed HCCMIS will make the changes accordingly I hope this information will allow the Bureau to conclude the handling of this file. If I can be of any further assistance, please let me know Sincerely, Jon Padgett, Vice President, Claims and Compliance HCC Medical Insurance Services
Revdex.com:I have reviewed the response made by the business in reference to complaint ID***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.The response from HCC is totally
untrueAs per HCC response I "was seen for Hypertensive chronic kidney disease, atherosclerotic heart disease headache, hypertension, cough, and hypoxemia on December 14, and December 15, 2015" is totally wrongI have attached here my hospital discharge instructions as a proofAs per my hospital discharge instructions, "you came to hospital for very high blood pressure and nausea, vomitingwe treated her high blood pressure and she improvedShe was also found to have low oxygen; we tested her lungs and she did not have a blood clotHer oxygeneation improved when we have her medications to remove the extra fluid"My old medication for my other diseases continued, which I used to take as per my Indian doctors instructionsThe only medication prescribed by doctor on 12/14/was to replace my blood pressure medication from Amlopres to AmlodipineMy blood pressure increased only because I ate somewhat high salt food in the previous nightDoctor recommeded in his discharge instruction to "eat a low salt diet"Furthermore, My hypertention (for which I saw doctor on 12/14/2015) is not chronic and not gradually becoming worseIt was under control through medicine and diet and it was undercontrol during the time I stayed in USA for another monthsI do have kidney disease but that also under control through medication and dietOn 12/14/2015, I didn't went to hospital for treatment for my kidney disease, nor any medical advice, diagnosis, care, or treatment was given for that diseaseFurthermore I don't have any atherosclerotic heart diseaseBecause of sudden high blood pressure, doctor did presecribed CT scan, Heart X-ray, and Lung scan to make sure there is no damage in any of these vital organsNote that I didn't go to doctor for problem in Heart, Lung or Brain and all my tests were normalI have test results from that date to provde thatComing to Visitor Secure plan policy, as per the benefit details in the brochure and the Vistorcoverge website (from where I took this insurance) inpatient hospitalization is coveredI have brochure to prove that and also anyone can see by him/herself at the following website: http://www.visitorscoverage.com/visitor-health-insurance/quotes/ Regards,*** ***
We apologize for the delay in processing Ms*** claimAfter reviewing Ms*** file, it is determined that her claim was properly paid under the terms and conditions of her policyhope this information will allow the Bureau to conclude the handling of this fileIf I can be of further
assistance, please let me knowRespectfully, Brittani S*** Compliance Assistant ***@hcclife.com
Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.[I talked with the *** *** *** (Provider) and they confirmed that they billed the HCC insurance for $onlySo I called HCC insurance and the customer service representative said that they separated the original $into two separate bills of $and $227.Can HCC insurance please confirm whether they will reprocess both these bills?]Regards,*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below. I have been promised several times in the last 10-months by HCC medical representatives that they are re-reviewing/escalating this case, however, every time I call back to check I hear that either there is no decision made or they need to escalate again. So, I will accept the solution and close the case once the payments are actually made.Please let me know once you do that.Hope you will understand my frustration and close this case ASAP.Thank you!
Regards,
*** ***
Please find HCC Life Insurance Company's response to the recent inquiry regarding Mr*** ***Thank you
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
[Provide details of why you are not satisfied with this resolution.]It has been four business days now and they have not contacted the hospital yet to try and resolve the billing issues of the overbilling.
Regards,
*** ***
Please see the attached response to the following complaint RE: Complainant: *** ***IN Revdex.com File #: ***Medical Insurance Services Group North Illinois Street, Suite 600, Indianapolis, IN, USA Tel: 317-262-Fax: 317-262-Toll Free:
800-605-2282 [email protected] hccmis.com November 3, 2016 Ms*** *** Revdex.com N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Complainant: *** *** IN Revdex.com File #: *** Dear Ms***, Mr*** *** a citizen of India purchased international travel coverage under our Atlas America Program for his travel inside the United StatesThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by Lloyds, London and Tokio Marine HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and AdministratorThe policy was active from August 24, to February 10, 2017. Mr*** was treated in the emergency room on September 3, The claims for that date of services have processed per the terms and conditions of the planAll follow up claims are pending a full set of medical records from the hospital in which Ms*** was treatedOnce received, we will continue our review of the remaining claims. I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll***@tmhcc.com
We have reviewed the issues raised in Mr*** complaintWe have determined that his claims have been properly processed under the terms and conditions of his policyIf I can be of any further assistance, please let me knowRespectfully, Charles ** *** Esq770/ 693-
***[email protected]
Please see the attached follow up in regards to the below complaint: RE: Complainant: *** ** IN Revdex.com File #: ***Dear Ms*** We have again reviewed the file for Ms**On June 28, 2016, via an appeal outcome letter, Ms** was informed that if medical records are received from the Urgent Care Center we will again review the claims on fileAt this time the medical records have not been submitted for review. I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll***@tmhcc.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below
Yes they DO have all of the documents "dr." Jorge Menendez has all of the items and given all of the continued rejections of my claimAs usual this company is providing any means possible for denying any claimI will spend another day at the hospital going through the corporate ** that HCCS does to avoid paymentThey have fine tuned their denial process as legal thievery sending me through the process over again to resend the paperwork that they already possessThey have done this repeatedly for othersThey are also in violation of the issuance of VISA health insurance with zero deductable
Regards,
*** ***
Please find attached HCC Life Insurance Company's response to the most recent follow up request regarding Mr*** ***. Thank you