After review of Mr. [redacted]' file, all claims have been processed according to the terms ans conditions of the plan. If I can be of further assistance, please let me know.Respectfully,Lori L[redacted]ParalegalHCC Life Insurance Company317/221-8013ll[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.
The response did not address the issue of pre-certification.
Regards,
[redacted]
We have reviewed Mr. [redacted] file. It appears we are still waiting to receive medical records from Mr. [redacted] physician. Once we received this information, we can proceed to process his claims. If we do not receive this information shortly, we will close our file. If I can be of further...
assistance, please let me know. Respectfully, Brittani [redacted] Compliance Assistant 770.693.6457 b[redacted]@hcclife.com
Please see the attached follow up response to complaint ID [redacted]. Thank you, Lori L[redacted]October 24, 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 follow up 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. While TMHCCMIS understands Mr. [redacted]s complaint; Mr. [redacted]s claims were processed per the terms and conditions of the plan. The policy contains the following: Eligible expenses: “Coinsurance – Claims incurred in US or Canada After the Deductible, Underwriters will pay 80% of Eligible Medical Expenses up to $5,000, then 100% to the Maximum Limit per Insured Person. The Coinsurance will be waived if satisfied with expenses incurred within the Preferred Provider Network.” “Eligible Medical Expenses Usual, Reasonable and Customary (Subject to Deductible and Coinsurance)” Exclusion: “9. Charges which exceed Usual, Reasonable and Customary; and” Mr. [redacted] also states that he has been told by TMHCC and the treating facility that “sometimes hospitals that may be within network contract with providers who are out of network”; this information is correct. While the facility is innetwork, it is not guaranteed that the individual physicians within the facility are in network. In Mr. [redacted]s case, the treating physician was not innetwork. Mr. [redacted] also states he was told by the provider that “the amount they bill is the same for the service, independent of whether the provider is considered in network or out of network.” Although TMHCC cannot speak on behalf of the provider, this information is most likely correct. The difference is that when a provider is innetwork, a discount is provided on those claims. Additionally, Mr. [redacted]s plan offers a waiver of coinsurance for an innetwork provider. Consequently, after review of the file, it has been determined that the claim on file has processed correctly. 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
RE: Complainant: [redacted] IN Revdex.com File#:[redacted] Dear Ms.[redacted] Ms.[redacted] a citizen of China purchased international travel coverage under our Atlas America Program for his trave linside the United States. The Group Master Policy is issued to the...
Atlas/International Citizens Group Insurance Trust,Hamilton Bermuda. This insurance is underwritten by [redacted] and [redacted] HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and Administrator.The policy was active from March 3,2016 to March 31, 2016. Ms. ** was seen on March 4,2016 for an ear infection.Per the receipt and documentation submitted by Ms. **,she was also provided a prescription for the ear infection on February 21,2016.Ms.** states the following in the documentation submitted: "For prescription with reason code 13:I do apologize that Isubmitted wrong receipt,which is dated 2/21/16.Iattached the correct receipt dated 3/4/16. "For prescription with reason code 23:this is not a pre-condition.The prescription was the refill for the same office visit.The first medicine didn't work so the doctor prescribed this one instead." (Boldness added) Because Ms.** had the ear infection prior to the start date of the policy,and was taking medication for the condition prior to the effective date,claims were appropriately denied per the below exclusion from the plan: EXCLUSION: "1. Pre-existing Conditions,as herein defined,except charges resulting directly from an Acute Onset of Pre-existing Condition,as herein defined,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." 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.
Regards,
[redacted] Dear [redacted], (Revdex.com Agent), this is [redacted] Again, representing Mrs [redacted], my mother in law, we are basically reopening complaint ID [redacted], please open this complaint to see what we were promised by HCC Medical Insurance services, and they have not honored. On the letter from HCC, dated 2-17-16, that we got thru you, the letter clearly states that the emergency visit Mrs [redacted] did on 12-6-15 was covered on the policy provisions, Mrs Lori L[redacted] from HCC even highlighted those provisions. Now a day later of the letter HCC sends me an explanation of benefits again denying coverage again. We believed in HCC promise to cover the emergency visit and we closed the complaint but now we want to reopen the complaint. We are attaching the following documents: -Letter from HCC dated 2-17-16 sent you (Revdex.com) saying that the emergency visit was covered -Explanation of benefits dated 2-18-16 sent after the letter saying they will not cover the emergency Dear [redacted] let me recall that FROM THE BEGINNING OUR INTENTION WAS TO GET INSURANCE MEDICAL COVERAGE FOR A VISITOR COMING INTO THE US TO USE IN CASE OF ILLNESS OR INJURY. WE WERE OFFERED THAT COVERAGE AND WE PURCHASED. They sold me a medical coverage for $50,000 maximum limit and $100 deductible per injury/illness. ON PHONE CONVERSATIONS WITH HCC THEY AFFIRMED THAT IN CASE OF ILLNESS TO VISIT THE NEAREST HEALTH FACILITY. THEY HAVE TO COVER [redacted] BECAUSE THEY MADE US BELIEVE THEY WERE SELLING INSURANCE FOR THE PURPOSE OF ILLNESS OR INJURY. [redacted] COVERAGE WEBSITE [redacted] SELLS [redacted] MEDICAL INSURANCE AND WE PAID THAT. PLEASE HELP US MAKE THINGS RIGHT. Again I will attach all supporting documentation I sent the first time, please contact HCC and ask why they do not want to honor their promised they did to you and us. Thanks you [redacted]WE WANT HCC TO HONOR THEIR LETTER DATED 2-17-16 SENT TO YOU AND US, ON COMPLAINT ID [redacted], SAYING THEY WILL COVER THE COMPLETE EXPENSE OF THE EMERGENCY VISIT ON 12-6-15 AS MRS LORI L[redacted] FROM HCC PROMISED ON THE LETTER.
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 have already paid off the provider and dont need any resolution from your end anymore as they had to send it to the collection agency. I just wanted to bring it to your notice that your staff had committed the mistake. Thanks for following up and please make sure this doesnt get repeated.
Regards,
[redacted]
Ms. [redacted] 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, Bermuda. The insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCCMIS) is the administrator.
HCCMIS has...
re-evaluated the claims submissions for Ms. [redacted]. Upon review, we agree that we will reprocess these claims subject to deductible and coinsurance. We apologize for the delay and inconvenience encountered by Ms. [redacted].Ms. [redacted] will receive new Explanation of Benefits shortly. In regards to the [redacted] HCCMIS only received a bill in the amout of $503.00; therefore, we will reprocess this claim in the amout of $503.00.
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,
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.]
An email requesting the check to be addressed and mailed to me and to my address has been sent.
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.
Before going to the doctor I called the phone number specified on insurance card and informed about my health situation. The agent asked me to go to that particular medical center. So since it's within your network I expect that you have agreement with the doctor about necessary paper work. I don't have any control over communication between the doctor and HCC. Moreover I can't verify the words that HCC didn't receive medical records since I provided fax number to medical center that I took from HCC (and HCC agents said that they can not call medical center themselves).There is overwhelming number of complaints online about the fact that HCC doesn't pay. If they don't pay the coverage then I expect that they will refund me full cost of insurance policy.
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]
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.]
I need the check to be mailed to my address here, not the one in Nepal.
Regards,
[redacted]
After further review we will be upholding the denial of the claims in question. 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,
[redacted]
Paralegal and Complaints Coordinator
HCC Medical Insurance Services
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted].Thank you
After review of Mr. [redacted]' file, all claims have been processed according to the terms ans conditions of the plan. If I can be of further assistance, please let me know.Respectfully,Lori L[redacted]ParalegalHCC Life Insurance Company317/221-8013ll[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.
The response did not address the issue of pre-certification.
Regards,
[redacted]
We have reviewed Mr. [redacted] file. It appears we are still waiting to receive medical records from Mr. [redacted] physician. Once we received this information, we can proceed to process his claims. If we do not receive this information shortly, we will close our file. If I can be of further...
assistance, please let me know. Respectfully, Brittani [redacted] Compliance Assistant 770.693.6457 b[redacted]@hcclife.com
Please see the attached follow up response to complaint ID [redacted]. Thank you, Lori L[redacted]October 24, 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 follow up 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. While TMHCCMIS understands Mr. [redacted]s complaint; Mr. [redacted]s claims were processed per the terms and conditions of the plan. The policy contains the following: Eligible expenses: “Coinsurance – Claims incurred in US or Canada After the Deductible, Underwriters will pay 80% of Eligible Medical Expenses up to $5,000, then 100% to the Maximum Limit per Insured Person. The Coinsurance will be waived if satisfied with expenses incurred within the Preferred Provider Network.” “Eligible Medical Expenses Usual, Reasonable and Customary (Subject to Deductible and Coinsurance)” Exclusion: “9. Charges which exceed Usual, Reasonable and Customary; and” Mr. [redacted] also states that he has been told by TMHCC and the treating facility that “sometimes hospitals that may be within network contract with providers who are out of network”; this information is correct. While the facility is innetwork, it is not guaranteed that the individual physicians within the facility are in network. In Mr. [redacted]s case, the treating physician was not innetwork. Mr. [redacted] also states he was told by the provider that “the amount they bill is the same for the service, independent of whether the provider is considered in network or out of network.” Although TMHCC cannot speak on behalf of the provider, this information is most likely correct. The difference is that when a provider is innetwork, a discount is provided on those claims. Additionally, Mr. [redacted]s plan offers a waiver of coinsurance for an innetwork provider. Consequently, after review of the file, it has been determined that the claim on file has processed correctly. 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
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you
RE: Complainant: [redacted] IN Revdex.com File#:[redacted] Dear Ms.[redacted] Ms.[redacted] a citizen of China purchased international travel coverage under our Atlas America Program for his trave linside the United States. The Group Master Policy is issued to the...
Atlas/International Citizens Group Insurance Trust,Hamilton Bermuda. This insurance is underwritten by [redacted] and [redacted] HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and Administrator.The policy was active from March 3,2016 to March 31, 2016. Ms. ** was seen on March 4,2016 for an ear infection.Per the receipt and documentation submitted by Ms. **,she was also provided a prescription for the ear infection on February 21,2016.Ms.** states the following in the documentation submitted: "For prescription with reason code 13:I do apologize that Isubmitted wrong receipt,which is dated 2/21/16.Iattached the correct receipt dated 3/4/16. "For prescription with reason code 23:this is not a pre-condition.The prescription was the refill for the same office visit.The first medicine didn't work so the doctor prescribed this one instead." (Boldness added) Because Ms.** had the ear infection prior to the start date of the policy,and was taking medication for the condition prior to the effective date,claims were appropriately denied per the below exclusion from the plan: EXCLUSION: "1. Pre-existing Conditions,as herein defined,except charges resulting directly from an Acute Onset of Pre-existing Condition,as herein defined,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." 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.
Regards,
[redacted] Dear [redacted], (Revdex.com Agent), this is [redacted] Again, representing Mrs [redacted], my mother in law, we are basically reopening complaint ID [redacted], please open this complaint to see what we were promised by HCC Medical Insurance services, and they have not honored. On the letter from HCC, dated 2-17-16, that we got thru you, the letter clearly states that the emergency visit Mrs [redacted] did on 12-6-15 was covered on the policy provisions, Mrs Lori L[redacted] from HCC even highlighted those provisions. Now a day later of the letter HCC sends me an explanation of benefits again denying coverage again. We believed in HCC promise to cover the emergency visit and we closed the complaint but now we want to reopen the complaint. We are attaching the following documents: -Letter from HCC dated 2-17-16 sent you (Revdex.com) saying that the emergency visit was covered -Explanation of benefits dated 2-18-16 sent after the letter saying they will not cover the emergency Dear [redacted] let me recall that FROM THE BEGINNING OUR INTENTION WAS TO GET INSURANCE MEDICAL COVERAGE FOR A VISITOR COMING INTO THE US TO USE IN CASE OF ILLNESS OR INJURY. WE WERE OFFERED THAT COVERAGE AND WE PURCHASED. They sold me a medical coverage for $50,000 maximum limit and $100 deductible per injury/illness. ON PHONE CONVERSATIONS WITH HCC THEY AFFIRMED THAT IN CASE OF ILLNESS TO VISIT THE NEAREST HEALTH FACILITY. THEY HAVE TO COVER [redacted] BECAUSE THEY MADE US BELIEVE THEY WERE SELLING INSURANCE FOR THE PURPOSE OF ILLNESS OR INJURY. [redacted] COVERAGE WEBSITE [redacted] SELLS [redacted] MEDICAL INSURANCE AND WE PAID THAT. PLEASE HELP US MAKE THINGS RIGHT. Again I will attach all supporting documentation I sent the first time, please contact HCC and ask why they do not want to honor their promised they did to you and us. Thanks you [redacted]WE WANT HCC TO HONOR THEIR LETTER DATED 2-17-16 SENT TO YOU AND US, ON COMPLAINT ID [redacted], SAYING THEY WILL COVER THE COMPLETE EXPENSE OF THE EMERGENCY VISIT ON 12-6-15 AS MRS LORI L[redacted] FROM HCC PROMISED ON THE LETTER.
Please see the attached response to complaint number [redacted] for [redacted]. Thank you, Lori L[redacted]
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.
I have already paid off the provider and dont need any resolution from your end anymore as they had to send it to the collection agency. I just wanted to bring it to your notice that your staff had committed the mistake. Thanks for following up and please make sure this doesnt get repeated.
Regards,
[redacted]
Please see the attached response to complaint [redacted]. Thank you, Lori L[redacted]
Please find HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you
Ms. [redacted] 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, Bermuda. The insurance is underwritten by Lloyds, London and HCC Medical Insurance Services (HCCMIS) is the administrator.
HCCMIS has...
re-evaluated the claims submissions for Ms. [redacted]. Upon review, we agree that we will reprocess these claims subject to deductible and coinsurance. We apologize for the delay and inconvenience encountered by Ms. [redacted].Ms. [redacted] will receive new Explanation of Benefits shortly. In regards to the [redacted] HCCMIS only received a bill in the amout of $503.00; therefore, we will reprocess this claim in the amout of $503.00.
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,
[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.
[Provide details of why you are not satisfied with this resolution.]
An email requesting the check to be addressed and mailed to me and to my address has been sent.
Regards,
[redacted]
Please find HCC Life Insurance Company's response to your inquiry regarding Ms. [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.
Before going to the doctor I called the phone number specified on insurance card and informed about my health situation. The agent asked me to go to that particular medical center. So since it's within your network I expect that you have agreement with the doctor about necessary paper work. I don't have any control over communication between the doctor and HCC. Moreover I can't verify the words that HCC didn't receive medical records since I provided fax number to medical center that I took from HCC (and HCC agents said that they can not call medical center themselves).There is overwhelming number of complaints online about the fact that HCC doesn't pay. If they don't pay the coverage then I expect that they will refund me full cost of insurance policy.
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]
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.]
I need the check to be mailed to my address here, not the one in Nepal.
Regards,
[redacted]
After further review we will be upholding the denial of the claims in question. 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,
[redacted]
Paralegal and Complaints Coordinator
HCC Medical Insurance Services