I have reviewed Mr. [redacted]'s file. The application required underwriting and was approved on January 11, 2016. A cancellation request was received on January 13, 2016 and processed the same day. At that time, the premiums were refunded to Mr. [redacted].If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life Insurance Company317/221-8013ll[redacted]@hccmis.com
Below are the responses to the latest questions:Regarding Claim # [redacted] - This claim did not take a deductible. See attached EOB.In regards to [redacted] - The first claim form the insured sent was on 7/28/15 and indicated the 3rd week of June, see attached. Because of this, we must rely on the first received information provided by the insured. As was indicated in the prior responses, these claims were correctly denied under pre-existing exclusion.
Please see the attached response regarding the following complaint: RE: Policy Administrator: [redacted] Revdex.com ID number: [redacted] Complainant: Mr. [redacted]...
[redacted] Insured: Mr. [redacted]Medical 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 October 7, 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 inquiry on behalf of Mr. [redacted]. Please be aware that this response may contain personal health information on the claimant. We trust the Bureau will only make this information available to those persons authorized to receive it. [redacted], a citizen of the United States, was insured with international travel coverage under our Samaritan’s Purse Major Medical plan. 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 policy was active from December 29, 2013 to January 22, 2016. We have reviewed the file and determined that the servicing provider is out of network. It is ultimately the provider’s decision if a discount will be provided. Our repricing department has reached out to the provider in attempt to negotiate a discount, and was unsuccessful. On July 22, 2016 the claim Mr. [redacted] has referenced was appropriately reprocessed showing the Usual, Reasonable, and Customary amount applied to Mr. [redacted]’s deductible. Please note the policy contains the following exclusion: “Charges which exceed Usual, Reasonable and Customary” Unfortunately, if the out of network provider is charging over the Usual, Reasonable, and Customary charge, TM HCCMIS has no control over this. 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 find that this resolution would be satisfactory to me.I will wait for the insurance's Explanation of Benefits and will give additional response after I receive my benefits.Thank you so much for your help with everything.
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.
They have lied to me and took my money without any satisfaction of services. They have not even tried calling me about this situation.
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.[Provide details of why you are not satisfied with this resolution.]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.
I called in months ago to have the pre-certification. The associate told me I don't have to do anything thing. I have phone conversation recorded. Please do a internal review of your customer service. At this stage, I am extremely frustrated.
Regards,
[redacted]
We have reviewed Ms. [redacted] file. It appears we are still waiting to receive medical records from Dr. [redacted]. [redacted]. Once we receive the necessary medical records, we can continue our investigation. If I can be of further assistance, please let me know. Respectfully, Brittani S[redacted]...
Mr. [redacted] was covered under our Visitor Secure policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, Bermuda. The insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCCMIS) is the...
administrator. Please note that the policy contains the below provision: “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 Certificate Termination Date 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) At this time two claims have been denied pending the receipt of medical records. The records requested are from East Valley Family Practice. This is the facility the policy holder was seen on April 27, 2015 and May 8, 2015. At minimum the facility will have records for these dates of service. Additionally, there is one claim on file for a hearing screening. The policy contains the below exclusion: “23. Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and any examination or fitting related to these devices, and all vision and hearing tests and examinations.” This claim appropriately denied per the above exclusion. 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 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 have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I filled out the release form for my medical records to be released to HCC. The form was received but they told me that HCC would have to pay a fee for the release of the medical records. HCC has not paid this fee so that is why they do not have the records. I am assuming that this means that I will have to pay the fee to get the medical records released and sent to HCC. Again, HCC is not paying anything. This has been my complaint from the start. HCC will not pay anything, and I am beginning to believe that even though they say they are going to re-review my claims, that this will never happen. Therefore I am hesitant to pay to have my medical records sent to them, when I believe that this will just be a waste of money for me. I really don't understand why HCC has such a good rating with the Revdex.com. From what I have read about HCC on the Revdex.com website, all the other messages from other clients of HCC have been complaints from the clients stating that they have had the same experiences that I have had, and that HCC never paid any of their claims either. I also know that HCC was sent some medical records from my doctor's office. If they received these records, have these records been reviewed and what was the outcome?
Regards,
[redacted]
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]
Mr. and Ms. [redacted] were covered under our Atlas policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, Bermuda. Coverage was purchased at 12:05pm on June 17th, 2015 with an effective date of the same day. Several claims...
were submitted for Ms. [redacted]. Claims incurred on 6/17/15 were correctly denied under the pre-existing exclusion as symptoms (per the members claim form) existed prior to the purchase of the policy. For claims incurred between 6/25 – 9/17, HCCMIS has requested medical records from Dr. [redacted]. Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy. Regarding claims for Mr. [redacted], the routine exam claim was correctly denied as not covered under the plan. For the remaining claims, HCCMIS has requested medical records from Dr. [redacted]. Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy. 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
We have reviewed Ms. [redacted] file. This policy specifically excludes pre-existing conditions. Based on the information provided, it is determined that Ms. [redacted] claims have been properly denied under the terms and conditions of her policy.
If I can be of further assistance,...
Please see the attached response in regards to the following complaint: RE: Complainant: [redacted] Policy Holder: [redacted] IN Revdex.com File #: [redacted] Thank you, Lori...
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.
Please understand that my Dad [redacted] did not have any preexisting condition.the symptoms were only noticed during his visit to US. Since he does not have any records of a preexisting medical condition in India. We request that this matter be resolved on an urgent basis. Please advice what we can provide to HCC Medical to open the file again. I have read information online that it is a common practice at this company to deny the claims made by the insured.
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.
I contacted HCC twice by phone before seeing the chiropractor and once after the first visit chiropractor and all three contacts did not mention I had to retrieve a referral from a physician. I called HCC twice on 9/17/13 before I saw the chiropractor. I do not have the phone records, but I believe that HCC has these phone records from my mobile line. My first call was to ask if I was covered and what procedures I had to go through. I was provided with a website of medical facilities that are covered. I was told to go and see any of them. I asked if there were any procedures but the customers relations officer told me I could go straight ahead and see the chiropractor. I made my way to the clinic and the reception told me that my insurance does not pay for treatments at the clinic as it was not a health insurance. SO I called HCC again to confirm everything. I was told to pay on my own and submit my claims. After my visit, I wrote in to HCC to get a written confirmation as I know the insurance companies here look for loopholes to not reimburse customers. REfer to the file Response from Delbert B. It was mentioned I was covered up to 50,000 but there was no mention that I had to see a physician prior to this. I appealed more t[redacted] 6 times to HCC and there was never once they responded to this. They ignored the fact they misled the consumer and gave no response to this.Also, I have attached an original reciept copy (I do not havce any copies anymore since HCC kept all my receipts and health insurance claim form). No where in the receipt was there a mention of physical therapy. I have also attacehd the original insurance policy document what states what Lori mentioned in fine print. I looked into that. but the line did not mention chiropractic therapy or the word chiro anywhere. As an average consumer, it is not possible to tell that chiropractic would belong to that category. It is not fair to me that HCC makes claims like these just to reject my claims.Lastly, I only got my claims results in late February. It took almost half a year for HCC to review my claims. I have contacted and askfor expedition via phone and mail multiple times but it took such a long time for them to conclude the rejection of my claims. They gave me misinformation to see a chiropractic and allowed me to see the chiropractor at my own expense to reject me at the end of the day, leaving me with a huge medical debt to deal with. I have done my due diligence to ensure that I was covered and done the right steps to seek medical help. I hope HCC would do the same and not give double standards in what they to consumers and in the end find other ways to not reimburse customers the way that should.T[redacted]k you Revdex.com. I sincerely hope you can help me out with this case.
Regards,
[redacted]
Please be advised that we processed the premium refund due to Mrs. [redacted] on September 11, 2015. I apologize for any inconvenience this has caused. If I can be of further assistance, please let me know. Respectfully, Lori L[redacted] Paralegal 317-221-8013 [redacted]
I have reviewed Mr. [redacted]'s file. The application required underwriting and was approved on January 11, 2016. A cancellation request was received on January 13, 2016 and processed the same day. At that time, the premiums were refunded to Mr. [redacted].If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life Insurance Company317/221-8013ll[redacted]@hccmis.com
Below are the responses to the latest questions:Regarding Claim # [redacted] - This claim did not take a deductible. See attached EOB.In regards to [redacted] - The first claim form the insured sent was on 7/28/15 and indicated the 3rd week of June, see attached. Because of this, we must rely on the first received information provided by the insured. As was indicated in the prior responses, these claims were correctly denied under pre-existing exclusion.
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you
Please see the attached response regarding the following complaint: RE: Policy Administrator: [redacted] Revdex.com ID number: [redacted] Complainant: Mr. [redacted]...
[redacted] Insured: Mr. [redacted]Medical 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 October 7, 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 inquiry on behalf of Mr. [redacted]. Please be aware that this response may contain personal health information on the claimant. We trust the Bureau will only make this information available to those persons authorized to receive it. [redacted], a citizen of the United States, was insured with international travel coverage under our Samaritan’s Purse Major Medical plan. 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 policy was active from December 29, 2013 to January 22, 2016. We have reviewed the file and determined that the servicing provider is out of network. It is ultimately the provider’s decision if a discount will be provided. Our repricing department has reached out to the provider in attempt to negotiate a discount, and was unsuccessful. On July 22, 2016 the claim Mr. [redacted] has referenced was appropriately reprocessed showing the Usual, Reasonable, and Customary amount applied to Mr. [redacted]’s deductible. Please note the policy contains the following exclusion: “Charges which exceed Usual, Reasonable and Customary” Unfortunately, if the out of network provider is charging over the Usual, Reasonable, and Customary charge, TM HCCMIS has no control over this. 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 find that this resolution would be satisfactory to me.I will wait for the insurance's Explanation of Benefits and will give additional response after I receive my benefits.Thank you so much for your help with everything.
Regards,
[redacted]
Please see the attached response to Revdex.com Id [redacted] 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.
They have lied to me and took my money without any satisfaction of services. They have not even tried calling me about this situation.
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.[Provide details of why you are not satisfied with this resolution.]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.
I called in months ago to have the pre-certification. The associate told me I don't have to do anything thing. I have phone conversation recorded. Please do a internal review of your customer service. At this stage, I am extremely frustrated.
Regards,
[redacted]
We have reviewed Ms. [redacted] file. It appears we are still waiting to receive medical records from Dr. [redacted]. [redacted]. Once we receive the necessary medical records, we can continue our investigation. If I can be of further assistance, please let me know. Respectfully, Brittani S[redacted]...
Compliance Assistant770.693.6457 [redacted]
Mr. [redacted] was covered under our Visitor Secure policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, Bermuda. The insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCCMIS) is the...
administrator. Please note that the policy contains the below provision: “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 Certificate Termination Date 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) At this time two claims have been denied pending the receipt of medical records. The records requested are from East Valley Family Practice. This is the facility the policy holder was seen on April 27, 2015 and May 8, 2015. At minimum the facility will have records for these dates of service. Additionally, there is one claim on file for a hearing screening. The policy contains the below exclusion: “23. Corrective devices and medical appliances, including eyeglasses, contact lenses, hearing aids, hearing implants, eye refraction, visual therapy, and any examination or fitting related to these devices, and all vision and hearing tests and examinations.” This claim appropriately denied per the above exclusion. 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 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 have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I filled out the release form for my medical records to be released to HCC. The form was received but they told me that HCC would have to pay a fee for the release of the medical records. HCC has not paid this fee so that is why they do not have the records. I am assuming that this means that I will have to pay the fee to get the medical records released and sent to HCC. Again, HCC is not paying anything. This has been my complaint from the start. HCC will not pay anything, and I am beginning to believe that even though they say they are going to re-review my claims, that this will never happen. Therefore I am hesitant to pay to have my medical records sent to them, when I believe that this will just be a waste of money for me. I really don't understand why HCC has such a good rating with the Revdex.com. From what I have read about HCC on the Revdex.com website, all the other messages from other clients of HCC have been complaints from the clients stating that they have had the same experiences that I have had, and that HCC never paid any of their claims either. I also know that HCC was sent some medical records from my doctor's office. If they received these records, have these records been reviewed and what was the outcome?
Regards,
[redacted]
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]
Mr. and Ms. [redacted] were covered under our Atlas policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, Bermuda. Coverage was purchased at 12:05pm on June 17th, 2015 with an effective date of the same day. Several claims...
were submitted for Ms. [redacted]. Claims incurred on 6/17/15 were correctly denied under the pre-existing exclusion as symptoms (per the members claim form) existed prior to the purchase of the policy. For claims incurred between 6/25 – 9/17, HCCMIS has requested medical records from Dr. [redacted]. Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy. Regarding claims for Mr. [redacted], the routine exam claim was correctly denied as not covered under the plan. For the remaining claims, HCCMIS has requested medical records from Dr. [redacted]. Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy. 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
Please see the attached response to the following complaint: RE: Complainant: [redacted] IN Revdex.com File #:[redacted] Thank you, Lori L[redacted]
We have reviewed Ms. [redacted] file. This policy specifically excludes pre-existing conditions. Based on the information provided, it is determined that Ms. [redacted] claims have been properly denied under the terms and conditions of her policy.
If I can be of further assistance,...
please let me know.
Respectfully,
Brittani [redacted]
Please see the attached response in regards to the following complaint: RE: Complainant: [redacted] Policy Holder: [redacted] IN Revdex.com File #: [redacted] 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.
Please understand that my Dad [redacted] did not have any preexisting condition.the symptoms were only noticed during his visit to US. Since he does not have any records of a preexisting medical condition in India. We request that this matter be resolved on an urgent basis. Please advice what we can provide to HCC Medical to open the file again. I have read information online that it is a common practice at this company to deny the claims made by the insured.
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.
I contacted HCC twice by phone before seeing the chiropractor and once after the first visit chiropractor and all three contacts did not mention I had to retrieve a referral from a physician. I called HCC twice on 9/17/13 before I saw the chiropractor. I do not have the phone records, but I believe that HCC has these phone records from my mobile line. My first call was to ask if I was covered and what procedures I had to go through. I was provided with a website of medical facilities that are covered. I was told to go and see any of them. I asked if there were any procedures but the customers relations officer told me I could go straight ahead and see the chiropractor. I made my way to the clinic and the reception told me that my insurance does not pay for treatments at the clinic as it was not a health insurance. SO I called HCC again to confirm everything. I was told to pay on my own and submit my claims. After my visit, I wrote in to HCC to get a written confirmation as I know the insurance companies here look for loopholes to not reimburse customers. REfer to the file Response from Delbert B. It was mentioned I was covered up to 50,000 but there was no mention that I had to see a physician prior to this. I appealed more t[redacted] 6 times to HCC and there was never once they responded to this. They ignored the fact they misled the consumer and gave no response to this.Also, I have attached an original reciept copy (I do not havce any copies anymore since HCC kept all my receipts and health insurance claim form). No where in the receipt was there a mention of physical therapy. I have also attacehd the original insurance policy document what states what Lori mentioned in fine print. I looked into that. but the line did not mention chiropractic therapy or the word chiro anywhere. As an average consumer, it is not possible to tell that chiropractic would belong to that category. It is not fair to me that HCC makes claims like these just to reject my claims.Lastly, I only got my claims results in late February. It took almost half a year for HCC to review my claims. I have contacted and askfor expedition via phone and mail multiple times but it took such a long time for them to conclude the rejection of my claims. They gave me misinformation to see a chiropractic and allowed me to see the chiropractor at my own expense to reject me at the end of the day, leaving me with a huge medical debt to deal with. I have done my due diligence to ensure that I was covered and done the right steps to seek medical help. I hope HCC would do the same and not give double standards in what they to consumers and in the end find other ways to not reimburse customers the way that should.T[redacted]k you Revdex.com. I sincerely hope you can help me out with this case.
Regards,
[redacted]
Please be advised that we processed the premium refund due to Mrs. [redacted] on September 11, 2015. I apologize for any inconvenience this has caused. If I can be of further assistance, please let me know. Respectfully, Lori L[redacted] Paralegal 317-221-8013 [redacted]