please see the attached response to the following complaint: RE: Complainant: [redacted] IN Revdex.com File #: [redacted]Dear Ms. [redacted], We have again reviewed the file for Mr. [redacted]. At this time we have not received itemized...
statements from any provider for an inpatient stay. We have received and paid claims related to three outpatient services. As included with our previous response, the policy contains the following in regards to timely filing of claims: “Proof of Claim – When Underwriters receive notice of claim, they will provide the Member with forms for filing Proof of Claim. The following is considered to be Proof of Claim: 1. A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments; and 2. Original itemized bills from Physicians, Hospitals and other medical providers; and 3. Original receipts for any expenses which have already been paid by or on behalf of the Member. The Member shall have 60 days beginning on the last day of the Certificate Period to submit Proof of Claim to Underwriters. Subsequent to receipt of Proof of Claim, Underwriters may, at their sole discretion, request and require additional information, including but not limited to medical records, necessary to confirm the validity of any claim prior to payment thereof.” (Boldness added) If this information is received within the above timely filing guidelines, we will review the claim and medical records to make a determination on payment. I hope this information will allow the Bureau to conclude the handling of this file. If I can be of any further assistance, please let me know. Sincerely, Lori L[redacted] Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll[redacted]@tmhcc.com
We have reviewed Mr. [redacted] file. It appears we are still waiting to receive medical records from Mr. [redacted] primary care physician. Once we receive the necessary medical records, we can continue our investigation.
If I can be of further assistance, please let me know.
Respectfully,
...
HCCMIS has reviewed the calls and the insured was incorrectly notified that a per-cert penalty would apply. We apologize for any confusion experienced by the insured. As was indicated in the prior response, HCCMIS will not apply the pre-cert penalty to the insured claims.Tell us why here...
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 10619350, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I have attached the...
documentation to support my denial of claims. HHC has consequently denied my claim based on pre-existing conditions, although this condition was not pre existing. I have also filed a complaint with WV Insurance Commission and they have heard of this company doing similar things. please read attachments to get the full idea of the situation. Thanks.
Regards,
Alexander Fatovic
After review of Ms. [redacted]'s file, we have determined all claims on file for her child processed appropriately per the terms of the policy.There is an application fee for each new policy purchased.If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life...
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.]The insurance company did pay $689 towards the claim. However that is nowhere near what should have been paid so far. I have accumulated bills of over $8,000 with a deductible of only 5000.
Regards,
[redacted]
After review of Mr. [redacted]'s file, we have determined all claims have been appropriately applied to Mr. [redacted]'s deductible. It appears the medical provider is billing in excess of the discounted amount of the claims. Our 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[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 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.
I called Memorial Hermann to see if they had received a request from HCC for my medical records. Memorial Hermann told me that "the treatment date on the authorization was not specified, and the right to revoke purpose re disclosure is missing, and the authorization has expired!" Memorial Hermann told me that they would fax another authorization to HCC. I tried to call Lori L[redacted] at HCC to let her know that they would be faxing her another authorization (and also to verify that the fax number Memorial Hermann had was correct), but the telephone number Lori L[redacted] gave me requires that you enter an extension, so I called the number (317) 262-2132 Ext [redacted], but it did not give me the option to enter an extension number, so I was not able to speak with her, or leave a message. I also called Mr. Charles M[redacted], Attorney, HCC Life Insurance Company at [redacted], but just got his voice mail, so I left a message for him on his voice mail. Sincerely, [redacted]
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 disagree with their response based on following facts:1. The only pre existing condition that I agree with is UC.2. The aneamia I had in 2013 was a direct result of profuse bleeding caused by severe UC Flare, which was resolved by blood transfusions and since then I never had any issues with aneamia.3. There are different type of aneamia, what I had recently was caused by low Iron Serum levels and low Iron Saturation and the cause could not be identified as I had no UC symptoms or any other health issues.4. The health insurance was sold to my mother on the basis that it covers 'pre existing conditions' otherwise my mother would have never purchased the insurance from HCCMIS. Hence this is gross misrepresentation by their representative.5. Under the new legislation in the US Insurance companies cannot deny a claim based on pre existing condition, they can normally give a waiting period of 6 months before they cover the pre-existing conditions but cannot deny claims indefinitely as HCCMIS is doing. As I am living in the US all laws are applicable to me equally.6. The reason to refuse claims for investigative procedures eg. Blood Tests, MRI is unacceptable- as that is part of investigation to understand the cause of any health issue I was facing.7. HCCMIS should pay all my bills in totality with $0 deductible.Thanking you.
Regards,
[redacted]
HCCMIS has received one claim on 6/9/2015 under certificate [redacted] for $3,887.84. This claim was processed as eligible on 7/17/2015 and the amount of the claim was reimbursed directly to the member. At no time was this claim denied for pre-existing conditions. No further action...
can be taken on this claim since the claim amount was reimbursed in full. I hope this information will allow the Bureau to conclude the handling of this file. If I can be of any further assistance, please let me know. Sincerely, Jon P[redacted] HCC Medical Insurance Services
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
Obviously, the HCC company didn't give any solutions or any apologies. They said I submitted a blank document on Feb. 6, but the truth is I submitted the appeal on Feb. 6 which is not blank because I submitted the same document again on March 7 by email (That time they said it is successful). Even if that was indeed blank due to their website issues, I didn't receive any response or reply from them to notice me (they admitted they did receive some document).Actually my concern is why they denied my claim. From the EOB letter they sent to me, it is very clear that the service provided by the doctor is related to my larynx. It's nothing related to the mental health. I went to see an ENT doctor (Dr. [redacted]) who specializes in Otolaryngology,not mental health. How could they connect a sore throat to mental disease? It's ridiculous. Attached is the EOB letter which includes the service description (service code [redacted] and [redacted]). None of these service are related to mental health.Thanks for your help,
Regards,
[redacted]
We have nothing to add to our previous response. The medical records received from her providers indicate that her treatment in April 2014 is related to her claims incurred in September 2014. Based upon her effective date in July 2014, these claims were properly handled. While her symptoms were acute, her treatment was for the same condition.
If I can be of further assistance, please let me know.
Respectfully,
Brittani [redacted]
Compliance Assistant
770.693.6457
[redacted]@hcclife.com
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.Below claim details are for Mrs [redacted]. I have given below the status of each claim also I have attached all the documents which I sent to HCC insurance company.I contacted Dr. [redacted] office about medical records and according to them, they have already submitted medical records to HCC insurance. As a proof they have given me below detailsClaim # [redacted]Ref # - [redacted]Attached documents contain1. Doctor's letter stating medical condition is not existing2. Outpatient minor surgery Authorization letter 3. Medical History4. Policy document which says policy effective from 06/17/2015.Claim # [redacted] Date of Service - 06/17/2015 Rejection reason - 23 - No Pre-X CoverageMy response - I have attached the policy document. Policy was effective from 06/17/2015Claim # [redacted] Date of Service - 06/17/2015 Rejection reason - 23 - No Pre-X CoverageMy response - I have attached the policy document. Policy was effective from 06/17/2015Claim # [redacted] Date of Service - 06/17/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/25/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/26/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/30/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/30/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/30/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 08/06/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 09/17/2015 My response - Status shows In Review, But no reasons provided.Below Claim details are for Mr. [redacted]. I have been asked to provide medical records for Mr. [redacted]. which I already submitted to HCC insurance. I'm here attaching the medical records too.I have contacted Dr. [redacted]'s office for medical record and they have also sent medical records to HCC insurance.Claim # [redacted] Date of Service - 08/14/2015 My response -Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 08/17/2015 My response -Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 09/04/2015 My response -Status shows In Review, But no reasons provided.Thanks,[redacted]
Please see the attached response for complaint #[redacted].
please see the attached response to the following complaint: RE: Complainant: [redacted] IN Revdex.com File #: [redacted]Dear Ms. [redacted], We have again reviewed the file for Mr. [redacted]. At this time we have not received itemized...
statements from any provider for an inpatient stay. We have received and paid claims related to three outpatient services. As included with our previous response, the policy contains the following in regards to timely filing of claims: “Proof of Claim – When Underwriters receive notice of claim, they will provide the Member with forms for filing Proof of Claim. The following is considered to be Proof of Claim: 1. A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments; and 2. Original itemized bills from Physicians, Hospitals and other medical providers; and 3. Original receipts for any expenses which have already been paid by or on behalf of the Member. The Member shall have 60 days beginning on the last day of the Certificate Period to submit Proof of Claim to Underwriters. Subsequent to receipt of Proof of Claim, Underwriters may, at their sole discretion, request and require additional information, including but not limited to medical records, necessary to confirm the validity of any claim prior to payment thereof.” (Boldness added) If this information is received within the above timely filing guidelines, we will review the claim and medical records to make a determination on payment. I hope this information will allow the Bureau to conclude the handling of this file. If I can be of any further assistance, please let me know. Sincerely, Lori L[redacted] Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-8013 ll[redacted]@tmhcc.com
We have reviewed Mr. [redacted] file. It appears we are still waiting to receive medical records from Mr. [redacted] primary care physician. 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 Assistant
770.693.6457
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you
HCCMIS has reviewed the calls and the insured was incorrectly notified that a per-cert penalty would apply. We apologize for any confusion experienced by the insured. As was indicated in the prior response, HCCMIS will not apply the pre-cert penalty to the insured claims.Tell us why here...
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID 10619350, and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.
I have attached the...
documentation to support my denial of claims. HHC has consequently denied my claim based on pre-existing conditions, although this condition was not pre existing. I have also filed a complaint with WV Insurance Commission and they have heard of this company doing similar things. please read attachments to get the full idea of the situation. Thanks.
Regards,
Alexander Fatovic
After review of Ms. [redacted]'s file, we have determined all claims on file for her child processed appropriately per the terms of the policy.There is an application fee for each new policy purchased.If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life...
Insurance COmpany317/221-8013l[redacted]@hccmis.com
Please see the attached response to the following complaint: RE: Complainant: [redacted] Revdex.com File #: 1[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.
[Provide details of why you are not satisfied with this resolution.]The insurance company did pay $689 towards the claim. However that is nowhere near what should have been paid so far. I have accumulated bills of over $8,000 with a deductible of only 5000.
Regards,
[redacted]
After review of Mr. [redacted]'s file, we have determined all claims have been appropriately applied to Mr. [redacted]'s deductible. It appears the medical provider is billing in excess of the discounted amount of the claims. Our 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[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 find that this resolution would be satisfactory to me.
Regards,
[redacted]
Please see the attached response to the following complaint: RE: Complainant: [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.
I called Memorial Hermann to see if they had received a request from HCC for my medical records. Memorial Hermann told me that "the treatment date on the authorization was not specified, and the right to revoke purpose re disclosure is missing, and the authorization has expired!" Memorial Hermann told me that they would fax another authorization to HCC. I tried to call Lori L[redacted] at HCC to let her know that they would be faxing her another authorization (and also to verify that the fax number Memorial Hermann had was correct), but the telephone number Lori L[redacted] gave me requires that you enter an extension, so I called the number (317) 262-2132 Ext [redacted], but it did not give me the option to enter an extension number, so I was not able to speak with her, or leave a message. I also called Mr. Charles M[redacted], Attorney, HCC Life Insurance Company at [redacted], but just got his voice mail, so I left a message for him on his voice mail. Sincerely, [redacted]
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 disagree with their response based on following facts:1. The only pre existing condition that I agree with is UC.2. The aneamia I had in 2013 was a direct result of profuse bleeding caused by severe UC Flare, which was resolved by blood transfusions and since then I never had any issues with aneamia.3. There are different type of aneamia, what I had recently was caused by low Iron Serum levels and low Iron Saturation and the cause could not be identified as I had no UC symptoms or any other health issues.4. The health insurance was sold to my mother on the basis that it covers 'pre existing conditions' otherwise my mother would have never purchased the insurance from HCCMIS. Hence this is gross misrepresentation by their representative.5. Under the new legislation in the US Insurance companies cannot deny a claim based on pre existing condition, they can normally give a waiting period of 6 months before they cover the pre-existing conditions but cannot deny claims indefinitely as HCCMIS is doing. As I am living in the US all laws are applicable to me equally.6. The reason to refuse claims for investigative procedures eg. Blood Tests, MRI is unacceptable- as that is part of investigation to understand the cause of any health issue I was facing.7. HCCMIS should pay all my bills in totality with $0 deductible.Thanking you.
Regards,
[redacted]
HCCMIS has received one claim on 6/9/2015 under certificate [redacted] for $3,887.84. This claim was processed as eligible on 7/17/2015 and the amount of the claim was reimbursed directly to the member. At no time was this claim denied for pre-existing conditions. No further action...
can be taken on this claim since the claim amount was reimbursed in full. 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
Please find attached 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.
Obviously, the HCC company didn't give any solutions or any apologies. They said I submitted a blank document on Feb. 6, but the truth is I submitted the appeal on Feb. 6 which is not blank because I submitted the same document again on March 7 by email (That time they said it is successful). Even if that was indeed blank due to their website issues, I didn't receive any response or reply from them to notice me (they admitted they did receive some document).Actually my concern is why they denied my claim. From the EOB letter they sent to me, it is very clear that the service provided by the doctor is related to my larynx. It's nothing related to the mental health. I went to see an ENT doctor (Dr. [redacted]) who specializes in Otolaryngology,not mental health. How could they connect a sore throat to mental disease? It's ridiculous. Attached is the EOB letter which includes the service description (service code [redacted] and [redacted]). None of these service are related to mental health.Thanks for your help,
Regards,
[redacted]
We have nothing to add to our previous response. The medical records received from her providers indicate that her treatment in April 2014 is related to her claims incurred in September 2014. Based upon her effective date in July 2014, these claims were properly handled. While her symptoms were acute, her treatment was for the same condition.
If I can be of further assistance, please let me know.
Respectfully,
Brittani [redacted]
Compliance Assistant
770.693.6457
[redacted]@hcclife.com
Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that the response would not resolve my complaint. For your reference, details of the offer I reviewed appear below.Below claim details are for Mrs [redacted]. I have given below the status of each claim also I have attached all the documents which I sent to HCC insurance company.I contacted Dr. [redacted] office about medical records and according to them, they have already submitted medical records to HCC insurance. As a proof they have given me below detailsClaim # [redacted]Ref # - [redacted]Attached documents contain1. Doctor's letter stating medical condition is not existing2. Outpatient minor surgery Authorization letter 3. Medical History4. Policy document which says policy effective from 06/17/2015.Claim # [redacted] Date of Service - 06/17/2015 Rejection reason - 23 - No Pre-X CoverageMy response - I have attached the policy document. Policy was effective from 06/17/2015Claim # [redacted] Date of Service - 06/17/2015 Rejection reason - 23 - No Pre-X CoverageMy response - I have attached the policy document. Policy was effective from 06/17/2015Claim # [redacted] Date of Service - 06/17/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/25/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/26/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/30/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/30/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 06/30/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 08/06/2015 My response - Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 09/17/2015 My response - Status shows In Review, But no reasons provided.Below Claim details are for Mr. [redacted]. I have been asked to provide medical records for Mr. [redacted]. which I already submitted to HCC insurance. I'm here attaching the medical records too.I have contacted Dr. [redacted]'s office for medical record and they have also sent medical records to HCC insurance.Claim # [redacted] Date of Service - 08/14/2015 My response -Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 08/17/2015 My response -Status shows In Review, But no reasons provided.Claim # [redacted] Date of Service - 09/04/2015 My response -Status shows In Review, But no reasons provided.Thanks,[redacted]