We have reviewed MrFatovic's file and issues addressed in his complaintMrFatovic states he has filed a complaint with the West Virginia Insurance CommissionDue to privacy concerns, we will provide a response to the Department of Insurance when the complaint is receivedIf I can be of further assistance, please let me knowRespectfully, Brittani S*** Compliance Assistant *** ***
Please see the attached response to the following complaint: Insured: *** ***Certificate Number: *** Revdex.com File number: *** Thank you, Lori L***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 July 7, 2016 *** *** Revdex.com N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Complainant: *** *** Insured: *** *** Certificate Number: *** Revdex.com File number: *** Dear Ms***, Ms*** *** purchased international travel coverage under our VacationUSA programMs*** applied for coverage under our Group Master Policy issued to the *** *** *** *** ***, *** ***This insurance is underwritten by *** *** and HCC Medical Insurance Services (HCCMIS) is the Coverholder and Administrator. We have reviewed Ms***’s file and determined that the claim in question has completed processing and a refund check for the full amount claimed was mailed to Ms*** on June 29, 2016. I hope this information will allow the Department to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal and Complaint Coordinator HCC Medical Insurance Services 317/221-8013 ll***@hccmis.com
Mr*** was covered under our Atlas policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, BermudaThe insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCCMIS) is the administrator
HCCMIS has
re-evaluated the claims submissions for Mr***Upon review, we agree with Mr*** that these claims were incorrectly denied and should be considered eligible for payment (subject to deductible and coinsurance)We will reprocess these claims immediately and have them sent to repricingWe apologize for the delay and inconvenience encountered by Mr***Mr*** will receive new Explanation of Benefits shortly
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,
Jon P***
HCC Medical Insurance Services
We have reviewed the claims on file for Ms***'s childAl claims have processed correctly per the terms and conditions of the plan.If I can be of further assistance, please let me know.Respectfully,Lori L***ParalegalHCC Life Insurance Company*** - directll***@hccmis.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
[The policy had an effective date of November I am attaching the policy informationHow could it be denied if it was within the policy effective dateThe policy was the renewed and every time there was a doctors visit, there was coverage
Regards,
*** ***
With regard to ***, my complaint was closed prematurelyYou indicated that you were under the understanding that I submitted the complaint for information purposes onlyThat is incorrectI submitted the complaint with the expectation of a formal response from the businessCan you please
reopen the complaint and forward it to the business for dispossession and response? Thank you
We have not received the requested records to continue review of Ms***'s claimsI have been in communication with Mr*** and she was informed what medical records are still needed to continue the investigationIf I can be of further assistance, please let me know.Respectfully, Lori L***ParalegalHCC Life Insurance Companyl***@hccmis.com317/221-
Medical records for both policies were received on
11/17/2015.For ***, outstanding claims have been processed as
eligible (subject to deductible and coinsurance) and sent to repricing.
Once they return from the repricing vendor, they will be released for
payment. For ***, Claim numbers *** and
***, and were determined to be eligible (subject to
deductible and coinsurance) and will be sent to repricing. Once they
return from the repricing vendor, they will be released for payment.
***, ***, ***, ***, *** were determined
to be pre-existing and therefore are excluded from coverage. For these
claims, the medical records show that weeks prior to coming to the US, the insured
had a suture placed under local anesthesia and told it would re-absorb on its
own. The insured was complaining that the suture was causing pain.
Since this issue began prior to the purchase of the policy, the claims are not
eligible for coverage.Sincerely,Jon P***
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 covered individual, *** ***, was diagnosed with DENGUE FEVER, which DOES NOT EXIST IN NEW YORK CITYFurthermore, the primary care physician who treated her on the day after her arrival indicated in writing that the condition was contracted during the coverage period overseasTherefore, the treatment falls within the Benefit Period as indicated in the response letter: "Up to days of home coverage after first day of diagnosis OR treatment of a covered injury OR illness while outside of home country"
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
No information provided on why even a standard doctor's visit would not be covered at all, leaving me with the full billNo information or resolution offered
Regards,
*** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me. I changed my address and Ms*** is in India right now, please have them contact me at the new address otherwise again the Insurance company will create issues later
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.Hi,I'm splitting my response in two parts. 1) For Mrs ***, Dr*** billing office sent you medical records multiple timesPls find attachmentSince they cannot provide me any other proof due to privacy concern, They sent me screenshot from their system showing medical records has been sent multiple times.Medical Records sent on below dates11/10/201507/31/201506/22/2015 2) For Mr ***, Dr*** Billing office sent you medical records on 11/09/but they have not received any response from HCC Travel insuranceThey cannot provide me any proof due to privacy concernI request you to kindly verify from your end and pls do contact the provider. Regards,*** ***
After review of Mr***'s file, we have determined all claims have been appropriately applied to Mr***'s deductibleIt appears the medical provider is billing in excess of the discounted amount of the claimsOur repricing department is reaching out to the provider to discuss this issue.If
I can be of further assistance, please let me know.Respectfully,Lori L***ParalegalHCC Life Insurance Company317/221-8013ll***@hccmis.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 yet. For
your reference, details of the offer I reviewed appear below
[Provide details of why you are not satisfied with this resolution.]
They have asked for policy numberHere it is: *** Forgive me, if this is not the way to proceedI'm not sure how to reply to them in your system
Regards,
*** ***
Dear Ms***,HCC Life Insurance Company has again reviewed the file for Mr*** *** and determined that all claims on file have processed per the terms and conditions of th eplanDue to HIPPA regulations we are unable to disclose Mr*** condition other than to note the policy does not pay for pre-existing conditions. Other claims are awaiting information requested from Mr*** to complete with processingMr*** may contact us for additional questions.If you have any additional questions please feel free to contact me.Respectfully, Lori L***ParalegalHCC Life Insurance Company - directll***@tmhcc.com
Please see the attached response
We have reviewed MrFatovic's file and issues addressed in his complaintMrFatovic states he has filed a complaint with the West Virginia Insurance CommissionDue to privacy concerns, we will provide a response to the Department of Insurance when the complaint is receivedIf I can be of further assistance, please let me knowRespectfully, Brittani S*** Compliance Assistant *** ***
Please see the attached response to the following complaint: Insured: *** ***Certificate Number: *** Revdex.com File number: *** Thank you, Lori L***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 July 7, 2016 *** *** Revdex.com N Delaware Street #2020 Indianapolis, IN 46204-2599 RE: Complainant: *** *** Insured: *** *** Certificate Number: *** Revdex.com File number: *** Dear Ms***, Ms*** *** purchased international travel coverage under our VacationUSA programMs*** applied for coverage under our Group Master Policy issued to the *** *** *** *** ***, *** ***This insurance is underwritten by *** *** and HCC Medical Insurance Services (HCCMIS) is the Coverholder and Administrator. We have reviewed Ms***’s file and determined that the claim in question has completed processing and a refund check for the full amount claimed was mailed to Ms*** on June 29, 2016. I hope this information will allow the Department to conclude the handling of this fileIf I can be of any further assistance, please let me know. Sincerely, Lori L*** Paralegal and Complaint Coordinator HCC Medical Insurance Services 317/221-8013 ll***@hccmis.com
Mr*** was covered under our Atlas policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, BermudaThe insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCCMIS) is the administrator
HCCMIS has
re-evaluated the claims submissions for Mr***Upon review, we agree with Mr*** that these claims were incorrectly denied and should be considered eligible for payment (subject to deductible and coinsurance)We will reprocess these claims immediately and have them sent to repricingWe apologize for the delay and inconvenience encountered by Mr***Mr*** will receive new Explanation of Benefits shortly
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,
Jon P***
HCC Medical Insurance Services
Please find attached HCC Life Insurance Company's response to your inquiry regarding Ms*** ***. Thank you
We have reviewed the claims on file for Ms***'s childAl claims have processed correctly per the terms and conditions of the plan.If I can be of further assistance, please let me know.Respectfully,Lori L***ParalegalHCC Life Insurance Company*** - directll***@hccmis.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
[The policy had an effective date of November I am attaching the policy informationHow could it be denied if it was within the policy effective dateThe policy was the renewed and every time there was a doctors visit, there was coverage
Regards,
*** ***
With regard to ***, my complaint was closed prematurelyYou indicated that you were under the understanding that I submitted the complaint for information purposes onlyThat is incorrectI submitted the complaint with the expectation of a formal response from the businessCan you please
reopen the complaint and forward it to the business for dispossession and response? Thank you
We have not received the requested records to continue review of Ms***'s claimsI have been in communication with Mr*** and she was informed what medical records are still needed to continue the investigationIf I can be of further assistance, please let me know.Respectfully, Lori L***ParalegalHCC Life Insurance Companyl***@hccmis.com317/221-
Medical records for both policies were received on
11/17/2015.For ***, outstanding claims have been processed as
eligible (subject to deductible and coinsurance) and sent to repricing.
Once they return from the repricing vendor, they will be released for
payment. For ***, Claim numbers *** and
***, and were determined to be eligible (subject to
deductible and coinsurance) and will be sent to repricing. Once they
return from the repricing vendor, they will be released for payment.
***, ***, ***, ***, *** were determined
to be pre-existing and therefore are excluded from coverage. For these
claims, the medical records show that weeks prior to coming to the US, the insured
had a suture placed under local anesthesia and told it would re-absorb on its
own. The insured was complaining that the suture was causing pain.
Since this issue began prior to the purchase of the policy, the claims are not
eligible for coverage.Sincerely,Jon P***
please see the attached response to the follow up on IN Revdex.com File # *** Thank you, Lori L***
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 covered individual, *** ***, was diagnosed with DENGUE FEVER, which DOES NOT EXIST IN NEW YORK CITYFurthermore, the primary care physician who treated her on the day after her arrival indicated in writing that the condition was contracted during the coverage period overseasTherefore, the treatment falls within the Benefit Period as indicated in the response letter: "Up to days of home coverage after first day of diagnosis OR treatment of a covered injury OR illness while outside of home country"
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
No information provided on why even a standard doctor's visit would not be covered at all, leaving me with the full billNo information or resolution offered
Regards,
*** ***
Please provide the policy number so that we may properly identify the insured's claims
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this resolution would be satisfactory to me. I changed my address and Ms*** is in India right now, please have them contact me at the new address otherwise again the Insurance company will create issues later
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.Hi,I'm splitting my response in two parts. 1) For Mrs ***, Dr*** billing office sent you medical records multiple timesPls find attachmentSince they cannot provide me any other proof due to privacy concern, They sent me screenshot from their system showing medical records has been sent multiple times.Medical Records sent on below dates11/10/201507/31/201506/22/2015 2) For Mr ***, Dr*** Billing office sent you medical records on 11/09/but they have not received any response from HCC Travel insuranceThey cannot provide me any proof due to privacy concernI request you to kindly verify from your end and pls do contact the provider. Regards,*** ***
Please see the attached respone to complaint ID of ***, for Mr***. Thank you, Lori L***
After review of Mr***'s file, we have determined all claims have been appropriately applied to Mr***'s deductibleIt appears the medical provider is billing in excess of the discounted amount of the claimsOur repricing department is reaching out to the provider to discuss this issue.If
I can be of further assistance, please let me know.Respectfully,Lori L***ParalegalHCC Life Insurance Company317/221-8013ll***@hccmis.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 yet. For
your reference, details of the offer I reviewed appear below
[Provide details of why you are not satisfied with this resolution.]
They have asked for policy numberHere it is: *** Forgive me, if this is not the way to proceedI'm not sure how to reply to them in your system
Regards,
*** ***
Dear Ms***,HCC Life Insurance Company has again reviewed the file for Mr*** *** and determined that all claims on file have processed per the terms and conditions of th eplanDue to HIPPA regulations we are unable to disclose Mr*** condition other than to note the policy does not pay for pre-existing conditions. Other claims are awaiting information requested from Mr*** to complete with processingMr*** may contact us for additional questions.If you have any additional questions please feel free to contact me.Respectfully, Lori L***ParalegalHCC Life Insurance Company - directll***@tmhcc.com