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
Regards,
*** *** Felt I was mislead into buying an insurance policyBefore buying the policy I called the customer service number to make sure I would qualify for the policyI specifically asked the customer service representative if going to the hospital a few weeks prior for chest pain, which turned out to be just heartburn (acid reflex) and she said that as long that I was not diagnosed as it being another condition or had to be prescribed medication to treat it, it would not be considered a pre-existing conditionAnd after buying the policy I again I called (on March 22) to make sure that received my payment and to make sure that the policy was in effect, I was told by another customer service representative that everything was good to go and that was was able to use my insurance if I needed to right away.Now HCC is denying payment of any sort for two hospital visits, a visit to my doctor, and a visit to a cardiologist that the doctor at the hospital insist that I go toAll because they say that I had a pre-existing condition if heartburn is considered a pre-exsiting condition, a ridiculous conclusion if you ask me So that they can get out of paying anythingShould of investigated the company better before buying a policy from themEspecially should of checked with the Revdex.com, I would of discovered that almost all the reviews of the company were negativeBecause of the bad information given to me by their representatives I paid for four months of insurance that covered nothing and am now stuck with hospital and other doctor bills that they wont paying for either
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
By HCC's response it is apparent that they still do not understand the basis of my complaintPer their statement they say that the claim was processed correctly as the Emergency Room physician that saw me comes up in their system as being out of network. My complaint still remains of why as a patient who went to an in network hospital that I am held responsible that the emergency room physician, who I did not have a choice of who I was going to see that day, happened to be out of networkThey state that HCC told me that “sometimes hospitals that
may be within network contract with providers who are out of network"They told me this after the fact, not beforeIf this is in fact written in their policy, I would like to see itPrior to utilizing the emergency room that day I actually did my due diligence in using HCC's website to look up which facilities were in network.
I still don't understand why in this matter that the patient is being held responsibleI still believe that HCC should be held responsible, though if they think the hospital or the emergency room physician group should be held responsible, I would be happy to file a complaint against either the hospital or the emergency room physician group on HCC's requestThis being said, as I stated in the details prior, when I had discussed this with the billers for the emergency room physician they said this issue was the responsibility of HCC, not them, and that they have had previous patients who were in similar situations who discussed this with their insurance companies and successfully obtained a pricing adjustment according to their reasonable request.
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
It doesn't make any sense to close the recordThey haven't tried contacting me to resolve this dispute.
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
Please see attachedMy child went in for the month well baby visit, these are state mandated benefits and should be paid in full.
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 cannot respond as to whether or not the response from the business has resolved my complaint I have not received their response in writing yet, so I do not know if it has resolved my complaint
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.Dear Sir, Insurance company stated that acute pre-existing condition will be approved, in my case also I had visited hospital emergency care as soon as I felt uncomfortable with healthI'm not sure why there was days mentioned in the documentationI was in journey prior to visiting hospital emergency care and during last day of my Journey I was having some kind of stomach bloating symptom, which I thought could be a symptom due to journey stress or digestion problem due to some kind of foodAs a first step (typical process) I have called my Family Doctor from India and got some advices to follow home remedy procedures, and also some over the counter medicationBy following home remedies and over the counter medication I felt symptoms were going down slowly The very next day I have reached to San Jose, CA and as soon as I observed symptoms are reappearing I have visited El Camino GH Emergency Care and after that I had followed by Hospital Procedures. For any Health related problem nobody visits directly emergency care unless it is a life threatening or critical or unbearable pain situation or a known pre-existing condition which could be worsen if treatment isn't started immediately. In my case I do not fall in to any of this categoriesMy health issue was started as a typical stomach bloating, for which as a first step I approached my family doctor and followed home remedies/over the counter medicationIf it is a known pre-existing condition I would have visited Hospital immediately, as Insurance stated it will be a Acute stateBut in my case I never had this symptom nor I know of this health issueIn fact I didn't know this as a pre-existing condition until Insurance company called it as and rejected claimsAs far as I know nobody would go to emergency care with out serious issue, which I followed tooAlready US hospitals are struck with so many unnecessary ER visits by many people and which is increasing their maintenance costAs a responsible US visitor with all these awareness I have followed standard process for my health issue (Family Doctor consultation, Home Remedies and ER visit)So I'm sincerely requesting Revdex.com to consider my urge and re-check Insurance company terms & conditions, which are not applicable for my medical case.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 will not be satisfied with my complaint until payments are made and verified for accuracy for all the outstanding claims.Regards,*** ***
Mr***, a citizen of India purchased international travel coverage under our Atlas America ProgramThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by Lloyds, London and HCC Medical Insurance Services
(HCCMIS) is the Coverholder and AdministratorThe policy had an effective date of May 18, and termination date of July 31, for Mr ***'s travel outsideof India including the United StatesThe member's certificate of coverage contains the following exclusion "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." The claimant statement submitted by Mr*** states that he had a fever for " few days" before he went to the emergency roomThis indicates that the symptoms started on May 19, The plan was effective on 5/18/It is within reasonable medical certainty that the contiion existed at the time of the applicationThe policy provides the following definition of and Actue onser of a pre-existing condition: "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 careThe Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policyTreatment must be obtained within hours of the sudden and unexpected outbreak or recurrenceA Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute OnsetThis 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) Consequently, we have appropriately denied the claims for Mr*** as a pre-existing conditionThat decision was upheld on appeal on November 24, 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 knowSincerely, Lori L*** Paralegal HCC Medical Insurance Services 317/221-l***@hccmis.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.Hi1) Mr. [redacted])For Claim # [redacted] - Pls issue cheque in the name of [redacted] (Son of Mr. [redacted]), So that we can cash it. My name is already on the authorization from for Mr. [redacted]. Pls, let me know if I need to complete any other formalities so that cheque can be issued in my name.2) Mrs. [redacted])I agree that for claims [redacted] and [redacted]. I’ll be responsible for payment. But for claim [redacted], though the first claim mentioned the third week of June, This claim form was mistakenly submitted by me. Since, I was not aware of how to fill the form, and this was my first experience with visitor insurance formality. However, This form, along with other forms, was later corrected when I got one more mail asking for submitting claimant statement again. This time, I checked with HCC customer support on how to submit the claimant statement. Hence, not for this claim, but for other claims also, you will find duplicate claimant statements.I hope, HCC will consider my plea and process all the claims rejected due to pre-existing coverage.
Regards,
[redacted]
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.Regards,[redacted]
"In the original complaint, I have stated that my case does not fall under a pre-existing condition. I have submitted medical records to prove that this claim has nothing to do with my pre-existing conditions. The fact that your response only regurgitates the fact that "this policy explicitly excludes pre-existing conditions" is disrespectful and irrelevant.
I kindly ask you to review the medical records I have provided, and you can see that my emergency visit had nothing to do with my pre-existing condition. If this does not resolved, I will have to resort to a small claim court."
HCCMIS has re-evaluated the claims submissions for Ms. [redacted]. Upon review, we agree to reprocess claim number [redacted] as eligible (subject to deductible and coinsurance). We will reprocess this claim immediately and have it sent to repricing. Once the claim has returned from repricing, Ms....
[redacted] will receive new Explanation of Benefits. 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 HCC Medical Insurance Services
Dear Ms. [redacted],Mr. [redacted] was covered under our Visitor Secure policy which is issued on a non-admitted basis to [redacted] Group Insurance Trust out of [redacted], Bermuda. The insurance is underwritten by [redacted], London and HCC Medical Insurance Services (HCCMIS) is the administrator. Please note that the policy contains the below provision: “ELIGIBLE MEDICAL EXPENSES – OUTPATIENT BENEFITS 5. Emergency room expenses, including charges for use of the emergency room itself and any supplies or other charges incurred during use of the emergency room for a covered Injury, even if Hospital confinement is not required, or for a covered Illness which results in hospitalization as Inpatient.” (boldness added) Ms. [redacted] was treated in the emergency room on an outpatient bases for an illness. The provider billed the claims with a diagnosis for enthesopathy. Consequently, the claims appropriately denied per the above exclusion. We have treated this complaint as an appeal. We have overturned our decision and allowed the claims. The claims will be paid at the fee schedule provided in the members plan. 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 and Complaints Coordinator
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.
HCC mentions in their letter that -(1) The service provided was for screening. Question: If a person is having "Rectal Bleeding" should the doctor not screen to find out the root cause of the issue before treating the condition?(2) They state that the condition had existed at the time of purchase. Just to be sure the policy was effective from June 1, 2016 to September 14, 2016. The service date was July 13, 2016, this service date is about 43 days after June 1, 2016. First and foremost the condition was not preexisting. If the condition "Rectal Bleeding" existed since June 1, 2016 (or before) to the best of my judgment a person would most likely be dead in 43 days. Can HCC please provide the evidence to substantiate that this condition existed.
Regards,
[redacted]
Ms. [redacted] purchased international travel coverage under our WorldMed program. Ms. [redacted] applied for coverage under our Group Master Policy issued to the Atlas/International Citizens Group Insurance Trust, Hamilton Bermuda. This insurance is underwritten by Lloyds, London and HCC Medical...
Insurance Services (HCCMIS) is the Coverholder and Administrator. Ms. [redacted], a citizen of Singapore, purchased coverage with an effective date of 11/14/2013 and termination date of 11/12/2014. Ms. [redacted] was provided the correct benefit information for Chiropractic visits. Unfortunately her claims were billed by the provider as physical therapy services. Please note the policy contains the below provision in regards to physical therapy: Eligible expenses: “18. Physical Therapy if prescribed by a Physician who is not affiliated with the Physical Therapy practice, necessarily incurred to continue recovery from a covered Injury or Illness.” To date we have not received a referral for the physical therapy benefits and the claims have been appropriately denied. I hope this information will allow the Department to conclude the [redacted]dling of this file. If I can be of any further assistance, please let me know. Sincerely, Lori L[redacted] Paralegal and Complaint Coordinator HCC Medical Insurance Services 317/221-8013 ll[redacted]@hccmis.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. We are confident HCC will honor its letter from 2-17-16 (sent thru the Revdex.com network) and pay the expenses for the emergency visit at [redacted] on 12-6-15.
Regards,
[redacted]
No pre-cert penalty will be applied.Thanks,Jon P***
Please find attached HCC Life Insurance Company's response to your inquiry regarding Ms*** ***. 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
Regards,
*** *** Felt I was mislead into buying an insurance policyBefore buying the policy I called the customer service number to make sure I would qualify for the policyI specifically asked the customer service representative if going to the hospital a few weeks prior for chest pain, which turned out to be just heartburn (acid reflex) and she said that as long that I was not diagnosed as it being another condition or had to be prescribed medication to treat it, it would not be considered a pre-existing conditionAnd after buying the policy I again I called (on March 22) to make sure that received my payment and to make sure that the policy was in effect, I was told by another customer service representative that everything was good to go and that was was able to use my insurance if I needed to right away.Now HCC is denying payment of any sort for two hospital visits, a visit to my doctor, and a visit to a cardiologist that the doctor at the hospital insist that I go toAll because they say that I had a pre-existing condition if heartburn is considered a pre-exsiting condition, a ridiculous conclusion if you ask me So that they can get out of paying anythingShould of investigated the company better before buying a policy from themEspecially should of checked with the Revdex.com, I would of discovered that almost all the reviews of the company were negativeBecause of the bad information given to me by their representatives I paid for four months of insurance that covered nothing and am now stuck with hospital and other doctor bills that they wont paying for either
See Attached
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
By HCC's response it is apparent that they still do not understand the basis of my complaintPer their statement they say that the claim was processed correctly as the Emergency Room physician that saw me comes up in their system as being out of network. My complaint still remains of why as a patient who went to an in network hospital that I am held responsible that the emergency room physician, who I did not have a choice of who I was going to see that day, happened to be out of networkThey state that HCC told me that “sometimes hospitals that
may be within network contract with providers who are out of network"They told me this after the fact, not beforeIf this is in fact written in their policy, I would like to see itPrior to utilizing the emergency room that day I actually did my due diligence in using HCC's website to look up which facilities were in network.
I still don't understand why in this matter that the patient is being held responsibleI still believe that HCC should be held responsible, though if they think the hospital or the emergency room physician group should be held responsible, I would be happy to file a complaint against either the hospital or the emergency room physician group on HCC's requestThis being said, as I stated in the details prior, when I had discussed this with the billers for the emergency room physician they said this issue was the responsibility of HCC, not them, and that they have had previous patients who were in similar situations who discussed this with their insurance companies and successfully obtained a pricing adjustment according to their reasonable request.
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
It doesn't make any sense to close the recordThey haven't tried contacting me to resolve this dispute.
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
Please see attachedMy child went in for the month well baby visit, these are state mandated benefits and should be paid in full.
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 cannot respond as to whether or not the response from the business has resolved my complaint I have not received their response in writing yet, so I do not know if it has resolved my complaint
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.Dear Sir, Insurance company stated that acute pre-existing condition will be approved, in my case also I had visited hospital emergency care as soon as I felt uncomfortable with healthI'm not sure why there was days mentioned in the documentationI was in journey prior to visiting hospital emergency care and during last day of my Journey I was having some kind of stomach bloating symptom, which I thought could be a symptom due to journey stress or digestion problem due to some kind of foodAs a first step (typical process) I have called my Family Doctor from India and got some advices to follow home remedy procedures, and also some over the counter medicationBy following home remedies and over the counter medication I felt symptoms were going down slowly The very next day I have reached to San Jose, CA and as soon as I observed symptoms are reappearing I have visited El Camino GH Emergency Care and after that I had followed by Hospital Procedures. For any Health related problem nobody visits directly emergency care unless it is a life threatening or critical or unbearable pain situation or a known pre-existing condition which could be worsen if treatment isn't started immediately. In my case I do not fall in to any of this categoriesMy health issue was started as a typical stomach bloating, for which as a first step I approached my family doctor and followed home remedies/over the counter medicationIf it is a known pre-existing condition I would have visited Hospital immediately, as Insurance stated it will be a Acute stateBut in my case I never had this symptom nor I know of this health issueIn fact I didn't know this as a pre-existing condition until Insurance company called it as and rejected claimsAs far as I know nobody would go to emergency care with out serious issue, which I followed tooAlready US hospitals are struck with so many unnecessary ER visits by many people and which is increasing their maintenance costAs a responsible US visitor with all these awareness I have followed standard process for my health issue (Family Doctor consultation, Home Remedies and ER visit)So I'm sincerely requesting Revdex.com to consider my urge and re-check Insurance company terms & conditions, which are not applicable for my medical case.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 will not be satisfied with my complaint until payments are made and verified for accuracy for all the outstanding claims.Regards,*** ***
Mr***, a citizen of India purchased international travel coverage under our Atlas America ProgramThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by Lloyds, London and HCC Medical Insurance Services
(HCCMIS) is the Coverholder and AdministratorThe policy had an effective date of May 18, and termination date of July 31, for Mr ***'s travel outsideof India including the United StatesThe member's certificate of coverage contains the following exclusion "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." The claimant statement submitted by Mr*** states that he had a fever for " few days" before he went to the emergency roomThis indicates that the symptoms started on May 19, The plan was effective on 5/18/It is within reasonable medical certainty that the contiion existed at the time of the applicationThe policy provides the following definition of and Actue onser of a pre-existing condition: "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 careThe Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policyTreatment must be obtained within hours of the sudden and unexpected outbreak or recurrenceA Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute OnsetThis 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) Consequently, we have appropriately denied the claims for Mr*** as a pre-existing conditionThat decision was upheld on appeal on November 24, 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 knowSincerely, Lori L*** Paralegal HCC Medical Insurance Services 317/221-l***@hccmis.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.Hi1) Mr. [redacted])For Claim # [redacted] - Pls issue cheque in the name of [redacted] (Son of Mr. [redacted]), So that we can cash it. My name is already on the authorization from for Mr. [redacted]. Pls, let me know if I need to complete any other formalities so that cheque can be issued in my name.2) Mrs. [redacted])I agree that for claims [redacted] and [redacted]. I’ll be responsible for payment. But for claim [redacted], though the first claim mentioned the third week of June, This claim form was mistakenly submitted by me. Since, I was not aware of how to fill the form, and this was my first experience with visitor insurance formality. However, This form, along with other forms, was later corrected when I got one more mail asking for submitting claimant statement again. This time, I checked with HCC customer support on how to submit the claimant statement. Hence, not for this claim, but for other claims also, you will find duplicate claimant statements.I hope, HCC will consider my plea and process all the claims rejected due to pre-existing coverage.
Regards,
[redacted]
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.Regards,[redacted]
"In the original complaint, I have stated that my case does not fall under a pre-existing condition. I have submitted medical records to prove that this claim has nothing to do with my pre-existing conditions. The fact that your response only regurgitates the fact that "this policy explicitly excludes pre-existing conditions" is disrespectful and irrelevant.
I kindly ask you to review the medical records I have provided, and you can see that my emergency visit had nothing to do with my pre-existing condition. If this does not resolved, I will have to resort to a small claim court."
Best,
[redacted] & [redacted]
HCCMIS has re-evaluated the claims submissions for Ms. [redacted]. Upon review, we agree to reprocess claim number [redacted] as eligible (subject to deductible and coinsurance). We will reprocess this claim immediately and have it sent to repricing. Once the claim has returned from repricing, Ms....
[redacted] will receive new Explanation of Benefits. 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 HCC Medical Insurance Services
Dear Ms. [redacted],Mr. [redacted] was covered under our Visitor Secure policy which is issued on a non-admitted basis to [redacted] Group Insurance Trust out of [redacted], Bermuda. The insurance is underwritten by [redacted], London and HCC Medical Insurance Services (HCCMIS) is the administrator. Please note that the policy contains the below provision: “ELIGIBLE MEDICAL EXPENSES – OUTPATIENT BENEFITS 5. Emergency room expenses, including charges for use of the emergency room itself and any supplies or other charges incurred during use of the emergency room for a covered Injury, even if Hospital confinement is not required, or for a covered Illness which results in hospitalization as Inpatient.” (boldness added) Ms. [redacted] was treated in the emergency room on an outpatient bases for an illness. The provider billed the claims with a diagnosis for enthesopathy. Consequently, the claims appropriately denied per the above exclusion. We have treated this complaint as an appeal. We have overturned our decision and allowed the claims. The claims will be paid at the fee schedule provided in the members plan. 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 and Complaints Coordinator
Please see the attached response to Revdex.com Complaint ID: [redacted]. Please let me know if you have any questions. Thank you, Lori L[redacted]
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.
HCC mentions in their letter that -(1) The service provided was for screening. Question: If a person is having "Rectal Bleeding" should the doctor not screen to find out the root cause of the issue before treating the condition?(2) They state that the condition had existed at the time of purchase. Just to be sure the policy was effective from June 1, 2016 to September 14, 2016. The service date was July 13, 2016, this service date is about 43 days after June 1, 2016. First and foremost the condition was not preexisting. If the condition "Rectal Bleeding" existed since June 1, 2016 (or before) to the best of my judgment a person would most likely be dead in 43 days. Can HCC please provide the evidence to substantiate that this condition existed.
Regards,
[redacted]
Ms. [redacted] purchased international travel coverage under our WorldMed program. Ms. [redacted] applied for coverage under our Group Master Policy issued to the Atlas/International Citizens Group Insurance Trust, Hamilton Bermuda. This insurance is underwritten by Lloyds, London and HCC Medical...
Insurance Services (HCCMIS) is the Coverholder and Administrator. Ms. [redacted], a citizen of Singapore, purchased coverage with an effective date of 11/14/2013 and termination date of 11/12/2014. Ms. [redacted] was provided the correct benefit information for Chiropractic visits. Unfortunately her claims were billed by the provider as physical therapy services. Please note the policy contains the below provision in regards to physical therapy: Eligible expenses: “18. Physical Therapy if prescribed by a Physician who is not affiliated with the Physical Therapy practice, necessarily incurred to continue recovery from a covered Injury or Illness.” To date we have not received a referral for the physical therapy benefits and the claims have been appropriately denied. I hope this information will allow the Department to conclude the [redacted]dling of this file. If I can be of any further assistance, please let me know. Sincerely, Lori L[redacted] Paralegal and Complaint Coordinator HCC Medical Insurance Services 317/221-8013 ll[redacted]@hccmis.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. We are confident HCC will honor its letter from 2-17-16 (sent thru the Revdex.com network) and pay the expenses for the emergency visit at [redacted] on 12-6-15.
Regards,
[redacted]
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you