Revdex.com:
I have reviewed the response made by the...
business in reference to complaint ID [redacted], and find that this response/resolution is satisfactory to me. But I didnt make any second level appeal. I hope they are reviewing it as it is.
Regards,
[redacted]
HCCMIS has reviewed the claims submissions for [redacted] and [redacted]. Since we have received proof from the medical providers of timely filing of the insured claims, HCCMIS agrees to reprocess all claims as eligible (subject to copays, deductible and coinsurance). We will...
reprocess these claims immediately and have them sent to repricing. Once the claims have returned from repricing, new Explanation of Benefits will be sent out. 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 P[redacted] HCC Medical Insurance Services
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve...
my complaint. For your reference, details of the offer I reviewed appear below.
I need to have writing proof of payments. I keep getting hospitals bills and phone calls including one yesterday after noon ( August 17, 2016) and the hospital has not received a single payment from the insurance company. In the insurance portal website. it still said that the case is close due to lack of patience records and that is patient responsibility to pay in full when I clearly send them 6 years of my medical records 3 times plus doctors note stating that's all their medical records they have of me.
Regards,
[redacted]
After review of Mr. [redacted]'s claim, we are awaiting a completed Accident Questionnaire to complete with processing. Once received, we will continue our review.If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life Insurance...
Please see that attached response to this follow upMedical Insurance Services Group 251 North Illinois Street, Suite 600, Indianapolis, IN, 46204 USA Tel: 317-262-2132 Fax: 317-262-2140 Toll Free: 800-605-2282 [email protected] hccmis.com September 12, 2016 Ms. [redacted] Revdex.com Serving Central Indiana 151 N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Policy Administrator: Tokio Marine HCC Medical Insurance Services Group Revdex.com ID number: [redacted] Complainant: Mr. [redacted] Insured: Mr. [redacted] Dear Ms. [redacted]: This is in response to your recent follow up inquiry on behalf of Mr.[redacted]. I apologize for the delayed response to this follow up. We have reviewed Mr. [redacted]s file and although he does not agree with the determination, we have sent notification to the provider that the medical records are needed to complete our review of the claims in question. At this time the requested medical records have not been received. If you need additional information, please let me know. Sincerely, Lori L[redacted] Paralegal and Complaints Coordinator Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll[redacted]@tmhcc.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
My name is [redacted]. I filed a complaint about Hcc medical insurance service. The ID is [redacted]. And the business responded that they have already approved my claims and will update me the new explanation of benefits within ten days on April 7th 2016. Then the case closed. But these two days I kept receiving letters from them requesting the same documents written in the complaint. When I called hccmis, they told me the very same thing as they told me before. So I supposed they didn't honestly process my claims as they said in the response. What should I do? Should I file another complaint? Thank you for help. Best regards, [redacted]
Please be advised that we have made adjustments to two of Mr. [redacted]' claims. However, other claims remain closed due to lack of information. All dependent claims have been properly processed under the terms and conditions of his policy. Mr. [redacted] may contact me if he has further concerns about...
outstanding information needed to process his claim. Respectfuly, Lori L[redacted] Paralegal HCC Life Insurance Company [email protected] 317/221-8013
Please be advised that we received and reviewed the records necessary to process Mr. [redacted] claims. Mr. [redacted] will receive a copy of his Explanation of Benefits after network repricing.
If I can be of further assistance, please let me know.
please see the attached response to the below complaint.RE: Complainant: [redacted] IN Revdex.com File #: [redacted]Thank you, Lori L[redacted]Dear Ms. P[redacted] We have again reviewed the file for Mr. [redacted]. At this time we have not received itemized statements from any provider for an inpatient stay. We have received and paid claims related to three outpatient services. As included with our previous response, the policy contains the following in regards to timely filing of claims: “Proof of Claim – When Underwriters receive notice of claim, they will provide the Member with forms for filing Proof of Claim. The following is considered to be Proof of Claim: 1. A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments; and 2. Original itemized bills from Physicians, Hospitals and other medical providers; and 3. Original receipts for any expenses which have already been paid by or on behalf of the Member. The Member shall have 60 days beginning on the last day of the Certificate Period to submit Proof of Claim to Underwriters. Subsequent to receipt of Proof of Claim, Underwriters may, at their sole discretion, request and require additional information, including but not limited to medical records, necessary to confirm the validity of any claim prior to payment thereof.” (Boldness added) If this information is received within the above timely filing guidelines, we will review the claim and medical records to make a determination on payment. 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, Lori L[redacted] Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll[redacted]@tmhcc.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Hi,I would like to thank HCC for taking efforts to solve my problems. However, there are few more issues need to be address before we close the request.Documents attached.1) Third Party Claim Form - Mr. [redacted]2) Third Party Claim Form - Mrs. [redacted]3) Banner Health Bill for Mrs. [redacted] showing deductibles and coinsurance paid ($1,562 USD)4) Policy document stating coinsurance clause and deductibles1) Mr. [redacted] ([redacted])All issues are addressed by HCC; I have attached filled Third Party claim form that I already sent to HCC via email and through online athttps://zone.hccmis.com2) Mrs. [redacted] ([redacted])I have attached and also send the Third Party Claim Form to HCC via email and through online (https://zone.hccmis.com). Claim # [redacted] - I have already paid deductibles as well as coinsurance. So total amount, I paid is $1,562 USD ($500 USD Deductible + $1,062 USD Coinsurance 20% of $5,000USD). Pls find attached bill from Banner Health. Since, Banner Health comes in PPO network and as per policy, Coinsurance needs to be waived. This mean I should reimburse this amount. ($1,062 USD - Third party form attached). Below is snippet from Policy document.Snippet -For the Certificate Period, Underwriters will pay 80% of the next $5,000 of Eligible Expenses after the Deductible, then 100% to the Overall Maximum Limit. Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider.Moreover, Pharmacy Bill in connection with claims of pre-existing condition needs to reimburse me. Below is the claim detail for Pharmacy Bill.Claim # [redacted] (Pharmacy Bill) - 188.95 USDSimilarly, I believe, since deductibles (500 USD) are already paid by me, below deductibles need to be taken care by HCC.Claim # [redacted] Deductible - $80.34 USDClaim # [redacted] Deductible - $92.65 USDClaim # [redacted] Deductible - $255.02 USDClaim # [redacted] Deductible - $118.69 USDClaim # [redacted] Deductible - $327.01 USDClaim # [redacted] Deductible - $327.01 USDClaim # [redacted] Deductible - $203.10 USD Total Deductible - $1403.82 USDI like to thanks again for providing resolution quickly.Thanks[redacted]
Regards,
[redacted]
The claims on file for Ms. [redacted] were appropriately denied based on the terms and conditions of her plan. If I can be of further assistance, please let me know Sincerely, Lori L[redacted] ParalegalHCC Life Insurance Company317.221.8013 direct ll[redacted]@hccmis.com
Please see the attached response. Thank you, LoriMedical Insurance Services Group 251 North Illinois Street, Suite 600, Indianapolis, IN, 46204 USA Tel: 317-262-2132 Fax: 317-262-2140 Toll Free: 800-605-2282 [email protected] hccmis.com August 31, 2016 Ms....
[redacted] Revdex.com 151 N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Complaint ID: [redacted] Complainant: [redacted] Insured: Mr. [redacted] and Ms. [redacted] Dear Ms. [redacted]: On February 3, 2016 Mr. [redacted] and Ms. [redacted], citizens of India, purchased international travel coverage under our Atlas America Program. The Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton Bermuda. This insurance is underwritten by Lloyds, London and Tokio Marine HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and Administrator. The policies were active from February 3, 2016 to July 24, 2016. With ID numbers [redacted] and [redacted]. Please note the policies contain the following exclusion: Exclusion: “42. Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as here in defined, are excluded from this insurance, except charges resulting directly from an Acute Onset of Pre-existing Condition, as herein defined, are covered for all Members subject to the limits set forth in the Schedule of Benefits and Limits.” Definition: “Pre-existing Condition: Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Preexisting Condition.” Definition: “Acute Onset of Pre-existing Condition: The term “Acute Onset of a Pre-Existing Condition(s)” shall mean a sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent care. The Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policy. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute Onset. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage.” (boldness added) Ms. [redacted] was seen for an injury on May 7, 2016. To complete with processing, we requested medical records. here on 7/30/2016. The claims were approved on August 23, 2016. Ms. [redacted] will receive an updated Explanation of Benefits within 7 business days. Mr. [redacted] was seen on April 16, 2016 through May 26, 2016. To complete with processing those claims, we requested medical records from the servicing provider. Those records were received on July 25, 2016. We are finalizing our review of the claims and Mr. [redacted] will receive an explanation of benefits within 10 business days. If you need additional information, please let me know. Sincerely, Lori [redacted] Paralegal and Complaints Coordinator Tokio Marine HCC Medical Insurance Services Group 317/221-8013 l[redacted]@tmhcc.com
Ms. [redacted],a citizen of India purchased internationaltravel coverage under our Atlas America Program. The Group Master Policy is...
issued to the Atlas/International Citizens Group Insurance Trust, Hamilton Bermuda. This insurance is underwritten by [redacted] and HCC Medical Insurance Services (HCCMIS} is the Coverholder and Administrator. The policy number is [redacted] and the plan is active from September 28,2015 to October 28,2015. Ms. [redacted] was taken to the Emergency Room via ambulance on October 21,2015.Please note the policy contains the following in regards to ambulance charges: "Local Ambulance Usual,Reasonable and Customary charges,when covered Illness or Injury results in hospitalization as Inpatient" Ms. [redacted] was not admitted as inpatient into the hospital. Consequently,the ambulance claim was correctly denied as a non-covered service. Please note that the policy contains the following in regards to emergency room services: "Emergency Room Co-payment- Claims incurred in U.S.or Canada -The Member shall be responsible for a $200 co-payment for each use of Emergency room for an Illness unless the Member is admitted to the Hospital. There will be no copayment for Emergency room treatment of an Injury." The claim for the emergency room services was approved and processed accordingly on December 14,2015. The clam in question for $790.00 was for the physician charges while in the emergency room.This claim was appropriately denied pending a HCFA from the provider.We have still not received this form;however,an exception has been made and the claim has been approved and sent to apply innetwork discounts.Once completed,Ms.[redacted] will receive an updated explanation of benefits showing the processing of the claim. Ms. [redacted] has a deductible of $1,000.00 as well as a copayment if not admitted into the hospital. If I can be of further assistance,please let me know. Respectfully, Lori L[redacted] Paralegal HCC Life Insurance Company 317/221-8013 l[redacted]@tmhcc.com
Please be advised that the company we have also received an appeal by Ms. [redacted]. We will address her concern in our response to her appeal since it concerns her medical condition Her appeal is currently being processed and she will receive a determination from our appeals department once...
complete.
If I can be of further assistance, please let me know.
Respectfully,
Brittani [redacted]
Compliance Assistant
770.693.6457
[redacted]@hcclife.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.
Regards,
[redacted]
Revdex.com:
I have reviewed the response made by the...
business in reference to complaint ID [redacted], and find that this response/resolution is satisfactory to me. But I didnt make any second level appeal. I hope they are reviewing it as it is.
Regards,
[redacted]
Please find HCC Life Insurance Company's response to your follow up inquiry. Thank you
HCCMIS has reviewed the claims submissions for [redacted] and [redacted]. Since we have received proof from the medical providers of timely filing of the insured claims, HCCMIS agrees to reprocess all claims as eligible (subject to copays, deductible and coinsurance). We will...
reprocess these claims immediately and have them sent to repricing. Once the claims have returned from repricing, new Explanation of Benefits will be sent out. 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 P[redacted] HCC Medical Insurance Services
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve...
my complaint. For your reference, details of the offer I reviewed appear below.
I need to have writing proof of payments. I keep getting hospitals bills and phone calls including one yesterday after noon ( August 17, 2016) and the hospital has not received a single payment from the insurance company. In the insurance portal website. it still said that the case is close due to lack of patience records and that is patient responsibility to pay in full when I clearly send them 6 years of my medical records 3 times plus doctors note stating that's all their medical records they have of me.
Regards,
[redacted]
Please see the attached response to complaint number [redacted] filed by [redacted] in regards to [redacted]. Thank you, Lori L[redacted]
After review of Mr. [redacted]'s claim, we are awaiting a completed Accident Questionnaire to complete with processing. Once received, we will continue our review.If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life Insurance...
Company317/221-8013ll[redacted]@hccmis.com
Please see that attached response to this follow upMedical Insurance Services Group 251 North Illinois Street, Suite 600, Indianapolis, IN, 46204 USA Tel: 317-262-2132 Fax: 317-262-2140 Toll Free: 800-605-2282 [email protected] hccmis.com September 12, 2016 Ms. [redacted] Revdex.com Serving Central Indiana 151 N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Policy Administrator: Tokio Marine HCC Medical Insurance Services Group Revdex.com ID number: [redacted] Complainant: Mr. [redacted] Insured: Mr. [redacted] Dear Ms. [redacted]: This is in response to your recent follow up inquiry on behalf of Mr.[redacted]. I apologize for the delayed response to this follow up. We have reviewed Mr. [redacted]s file and although he does not agree with the determination, we have sent notification to the provider that the medical records are needed to complete our review of the claims in question. At this time the requested medical records have not been received. If you need additional information, please let me know. Sincerely, Lori L[redacted] Paralegal and Complaints Coordinator Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll[redacted]@tmhcc.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
My name is [redacted]. I filed a complaint about Hcc medical insurance service. The ID is [redacted]. And the business responded that they have already approved my claims and will update me the new explanation of benefits within ten days on April 7th 2016. Then the case closed. But these two days I kept receiving letters from them requesting the same documents written in the complaint. When I called hccmis, they told me the very same thing as they told me before. So I supposed they didn't honestly process my claims as they said in the response. What should I do? Should I file another complaint? Thank you for help. Best regards, [redacted]
Please be advised that we have made adjustments to two of Mr. [redacted]' claims. However, other claims remain closed due to lack of information. All dependent claims have been properly processed under the terms and conditions of his policy. Mr. [redacted] may contact me if he has further concerns about...
outstanding information needed to process his claim. Respectfuly, Lori L[redacted] Paralegal HCC Life Insurance Company [email protected] 317/221-8013
Please be advised that we received and reviewed the records necessary to process Mr. [redacted] claims. Mr. [redacted] will receive a copy of his Explanation of Benefits after network repricing.
If I can be of further assistance, please let me know.
Respectfully,
Brittani...
[redacted]
ComplianceAssistant
770.693.6457
b[redacted]@hcclife.com
please see the attached response to the below complaint.RE: Complainant: [redacted] IN Revdex.com File #: [redacted]Thank you, Lori L[redacted]Dear Ms. P[redacted] We have again reviewed the file for Mr. [redacted]. At this time we have not received itemized statements from any provider for an inpatient stay. We have received and paid claims related to three outpatient services. As included with our previous response, the policy contains the following in regards to timely filing of claims: “Proof of Claim – When Underwriters receive notice of claim, they will provide the Member with forms for filing Proof of Claim. The following is considered to be Proof of Claim: 1. A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments; and 2. Original itemized bills from Physicians, Hospitals and other medical providers; and 3. Original receipts for any expenses which have already been paid by or on behalf of the Member. The Member shall have 60 days beginning on the last day of the Certificate Period to submit Proof of Claim to Underwriters. Subsequent to receipt of Proof of Claim, Underwriters may, at their sole discretion, request and require additional information, including but not limited to medical records, necessary to confirm the validity of any claim prior to payment thereof.” (Boldness added) If this information is received within the above timely filing guidelines, we will review the claim and medical records to make a determination on payment. 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, Lori L[redacted] Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll[redacted]@tmhcc.com
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Hi,I would like to thank HCC for taking efforts to solve my problems. However, there are few more issues need to be address before we close the request.Documents attached.1) Third Party Claim Form - Mr. [redacted]2) Third Party Claim Form - Mrs. [redacted]3) Banner Health Bill for Mrs. [redacted] showing deductibles and coinsurance paid ($1,562 USD)4) Policy document stating coinsurance clause and deductibles1) Mr. [redacted] ([redacted])All issues are addressed by HCC; I have attached filled Third Party claim form that I already sent to HCC via email and through online athttps://zone.hccmis.com2) Mrs. [redacted] ([redacted])I have attached and also send the Third Party Claim Form to HCC via email and through online (https://zone.hccmis.com). Claim # [redacted] - I have already paid deductibles as well as coinsurance. So total amount, I paid is $1,562 USD ($500 USD Deductible + $1,062 USD Coinsurance 20% of $5,000USD). Pls find attached bill from Banner Health. Since, Banner Health comes in PPO network and as per policy, Coinsurance needs to be waived. This mean I should reimburse this amount. ($1,062 USD - Third party form attached). Below is snippet from Policy document.Snippet -For the Certificate Period, Underwriters will pay 80% of the next $5,000 of Eligible Expenses after the Deductible, then 100% to the Overall Maximum Limit. Coinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider.Moreover, Pharmacy Bill in connection with claims of pre-existing condition needs to reimburse me. Below is the claim detail for Pharmacy Bill.Claim # [redacted] (Pharmacy Bill) - 188.95 USDSimilarly, I believe, since deductibles (500 USD) are already paid by me, below deductibles need to be taken care by HCC.Claim # [redacted] Deductible - $80.34 USDClaim # [redacted] Deductible - $92.65 USDClaim # [redacted] Deductible - $255.02 USDClaim # [redacted] Deductible - $118.69 USDClaim # [redacted] Deductible - $327.01 USDClaim # [redacted] Deductible - $327.01 USDClaim # [redacted] Deductible - $203.10 USD Total Deductible - $1403.82 USDI like to thanks again for providing resolution quickly.Thanks[redacted]
Regards,
[redacted]
The claims on file for Ms. [redacted] were appropriately denied based on the terms and conditions of her plan. If I can be of further assistance, please let me know Sincerely, Lori L[redacted] ParalegalHCC Life Insurance Company317.221.8013 direct ll[redacted]@hccmis.com
Please see the attached response. Thank you, LoriMedical Insurance Services Group 251 North Illinois Street, Suite 600, Indianapolis, IN, 46204 USA Tel: 317-262-2132 Fax: 317-262-2140 Toll Free: 800-605-2282 [email protected] hccmis.com August 31, 2016 Ms....
[redacted] Revdex.com 151 N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Complaint ID: [redacted] Complainant: [redacted] Insured: Mr. [redacted] and Ms. [redacted] Dear Ms. [redacted]: On February 3, 2016 Mr. [redacted] and Ms. [redacted], citizens of India, purchased international travel coverage under our Atlas America Program. The Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton Bermuda. This insurance is underwritten by Lloyds, London and Tokio Marine HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and Administrator. The policies were active from February 3, 2016 to July 24, 2016. With ID numbers [redacted] and [redacted]. Please note the policies contain the following exclusion: Exclusion: “42. Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as here in defined, are excluded from this insurance, except charges resulting directly from an Acute Onset of Pre-existing Condition, as herein defined, are covered for all Members subject to the limits set forth in the Schedule of Benefits and Limits.” Definition: “Pre-existing Condition: Any (1) condition for which medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) was recommended or received during the 2 years immediately preceding the Certificate Effective Date; (2) condition that had manifested itself in such a manner that would have caused a reasonably prudent person to seek medical advice, diagnosis, care, or treatment (includes receiving services and supplies, consultations, diagnostic tests or prescription medicines) within the 2 years immediately preceding the Certificate Effective Date; (3) injury, illness, sickness, disease, or other physical, medical, mental, or nervous conditions, disorder or ailment (whether known or unknown) that, with reasonable medical certainty, existed at the time of application or within the 2 years immediately preceding the Certificate Effective Date. For the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Preexisting Condition.” Definition: “Acute Onset of Pre-existing Condition: The term “Acute Onset of a Pre-Existing Condition(s)” shall mean a sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent care. The Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policy. Treatment must be obtained within 24 hours of the sudden and unexpected outbreak or recurrence. A Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute Onset. This benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage.” (boldness added) Ms. [redacted] was seen for an injury on May 7, 2016. To complete with processing, we requested medical records. here on 7/30/2016. The claims were approved on August 23, 2016. Ms. [redacted] will receive an updated Explanation of Benefits within 7 business days. Mr. [redacted] was seen on April 16, 2016 through May 26, 2016. To complete with processing those claims, we requested medical records from the servicing provider. Those records were received on July 25, 2016. We are finalizing our review of the claims and Mr. [redacted] will receive an explanation of benefits within 10 business days. If you need additional information, please let me know. Sincerely, Lori [redacted] Paralegal and Complaints Coordinator Tokio Marine HCC Medical Insurance Services Group 317/221-8013 l[redacted]@tmhcc.com
Ms. [redacted],a citizen of India purchased internationaltravel coverage under our Atlas America Program. The Group Master Policy is...
issued to the Atlas/International Citizens Group Insurance Trust, Hamilton Bermuda. This insurance is underwritten by [redacted] and HCC Medical Insurance Services (HCCMIS} is the Coverholder and Administrator. The policy number is [redacted] and the plan is active from September 28,2015 to October 28,2015. Ms. [redacted] was taken to the Emergency Room via ambulance on October 21,2015.Please note the policy contains the following in regards to ambulance charges: "Local Ambulance Usual,Reasonable and Customary charges,when covered Illness or Injury results in hospitalization as Inpatient" Ms. [redacted] was not admitted as inpatient into the hospital. Consequently,the ambulance claim was correctly denied as a non-covered service. Please note that the policy contains the following in regards to emergency room services: "Emergency Room Co-payment- Claims incurred in U.S.or Canada -The Member shall be responsible for a $200 co-payment for each use of Emergency room for an Illness unless the Member is admitted to the Hospital. There will be no copayment for Emergency room treatment of an Injury." The claim for the emergency room services was approved and processed accordingly on December 14,2015. The clam in question for $790.00 was for the physician charges while in the emergency room.This claim was appropriately denied pending a HCFA from the provider.We have still not received this form;however,an exception has been made and the claim has been approved and sent to apply innetwork discounts.Once completed,Ms.[redacted] will receive an updated explanation of benefits showing the processing of the claim. Ms. [redacted] has a deductible of $1,000.00 as well as a copayment if not admitted into the hospital. If I can be of further assistance,please let me know. Respectfully, Lori L[redacted] Paralegal HCC Life Insurance Company 317/221-8013 l[redacted]@tmhcc.com
Yes, both bills will be reprocessed.
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you
Please be advised that the company we have also received an appeal by Ms. [redacted]. We will address her concern in our response to her appeal since it concerns her medical condition Her appeal is currently being processed and she will receive a determination from our appeals department once...
complete.
If I can be of further assistance, please let me know.
Respectfully,
Brittani [redacted]
Compliance Assistant
770.693.6457
[redacted]@hcclife.com
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution would be satisfactory to me.
Regards,
[redacted]