HCCMIS has reviewed the claims submitted by [redacted]. After review, the claims related to the pregnancy are covered under the policy (subject to deductible and coinsurance). HCCMIS will process these and send out new Explanation of Benefits after they are repriced. Any previously...
denied pregnancy claims will be reprocessed as well. 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
After review of Mr. [redacted]'s claims, HCC Life Insurance Company did reach out to the provider who has refused the discount. On December 28, 2015 a new explanation of benefits was sent to Mr. [redacted] showing the updated processing of the claims in question,If I can be of further assistance, please let me know.Respectfully,Lori L[redacted]ParalegalHCC Life Insurance Company317/221-8013ll[redacted]@hccmis.com
HCCMIS has re-evaluated the claims submissions for Mr. [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 to repricing. Once the claim has...
returned from repricing, Mr. [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 P[redacted] HCC Medical Insurance Services
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. Thank you for your help in this matter.
Regards,
[redacted]
Regarding #2, coinsurance has already been waived. This is indicated on the Explanation of Benefit forms that are mailed to both the member and provider. If Mr. [redacted] has overpaid on coinsurance to the provider, he must seek a refund from the provider directly. HCCMIS does not reimburse for these overpayments by the member. Regarding deductible, below is how the deductible was applied. Claim # [redacted] Deductible - $80.34 USD Claim # [redacted] Deductible - $92.65 USD Claim # [redacted] Deductible - $208.32 USD (See attached EOB) Claim # [redacted] Deductible - $118.69 USD Claim # [redacted] Deductible - $0.00 USD (See attached EOB) Claim # [redacted] Deductible - $0.00 USD (See attached EOB) Claim # [redacted] Deductible - $0.00 USD (See attached EOB) As was indicated in the response regarding coinsurance, if Mr. [redacted] has overpaid the provider for the deductible, he must seek a refund from the provider directly. HCCMIS does not reimburse for these overpayments by the member. Lastly, for [redacted] , this was related to the other 6/17/15 claims that were denied pre-existing ([redacted] and [redacted]). Mr. [redacted] agreed these were not eligible in a prior response; therefore, no exception was made for this claim.
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.
A few weeks ago, I sent paperwork stating that HCC Medical Services should refund me the money I spent out of pocket. The claims aren't even on the website. I've attached those bills to this response so the Revdex.com and HCC Medical Services can see what bills I'm talking about. I received another notice from one of the hospitals I went to (From a Dr. [redacted] at the Peninsula Urology Center) and they are still awaiting payment from HCC Medical Services, and I would like to add this claim isn't even on the website, even though I sent it in AND gave them medical records from Dr. [redacted]'s office.I will RESEND my claims and give them one last time to resolve these issues. Thank you, Revdex.com for following up on this issue and look forward to a resolution to his problem.[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.
[Provide details of why you are not satisfied with this resolution.]
Regards,
[redacted]
We have reviewed Ms. [redacted] file and determined that she requested to cancel her policy after the 10 day free look period on her policy. Consequently, she is no longer eligible for a full refund of her premiums. I hope this information will allow the Bureau to conclude the handling of this...
file. If I can be of further assistance, please let me know. Respectfully, Brittani S[redacted] Compliance Assistant 770.693.6457 b[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.I think the cause of the misunderstanding is the 2/21 prescription bill. I've attached original doctor's prescription and the bill from pharmacy. You can see that the 2/21 prescription is for another person, not for me. Please let me know if you need further information.
Regards,
[redacted]
We have reviewed Ms. [redacted] file and issues in her complaint. Unfortunately, the services were excluded under her policy. Consequently, her claims were properly denied under the terms and conditions of her policy. If I can be of further assistance, please let me...
We have not received a request to cancel Ms. [redacted]'s plan. If this request was sent to a broker, we would be happy to refund any premiums taken after the request if the original request is forwarded to me directly at l[redacted]@hccmis.com. Additionally, we have cancelled the plan as of March 13,...
2016 and no future payments will be taken.
If I can be of further assistance, please let me know.
Respectfully,
Lori [redacted]
Paralegal
HCC Life Iinsurance company
317-221-8013
HCCMIS has reprocessed the claim as eligible. A new EOB and check will be mailed to the address on file in Nepal. 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
The claim was processed to the address provided by the insured. Address changes can only be initiated by the insured. If an address change is needed, please have the insured email me directly at j[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.
This complaint was filed against HCC regarding my emergency room visit that I made to [redacted] Center Emergency room in Colorado Springs, CO on December 4, 2015. To sum up the reason for my complaint, the [redacted] Center Emergency Room was listed as within HCC insurances covered network, which I verified before I went, and I also verified with their customer service agents after the fact. My complaint is regarding why, if I went to an in-network emergency room, I am being billed for an out-of-network emergency room provider. I have been told by both [redacted] Center and HCC that sometimes hospitals that may be within network contract with providers who are out of network. As a patient in the emergency room I have no choice which provider takes care of me. And thus I am asking, why is it fair to me that I am being billed for an out-of-network physician service when I went to an in-network emergency room? The response that HCC has provided the Revdex.com is the same response I have gotten before from their customer service agents--because in their system the provider comes up as "out of network." By this I can tell that they still don't understand the nature of my complaint. I understand that the provider is coming up as "out of network" in their system. My question is again, why am I being billed for an out of network physician service that took place in an "in network" emergency room where I could not choose my provider? I am also confused by the rest of HCC's response, that "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 June 3, 2016, in my confusion I called [redacted] Specialists who bills for the emergency room physicians for [redacted] hospital to inquire about my bill, and they told me that the amount they bill is the same for the service, independent of whether the provider is considered in network or out of network. It is the same charge, but why I am responsible for is determined by the insurance whether it is considered in or out of network. When I told them that HCC told me otherwise, I got a representative from HCC on the phone with [redacted], and they got in a dispute on the phone and were talking past one another. The HCC representative managed to pass the phone call on to the pricing dispute department, who conveniently were closed for the day. The [redacted] agent at this point told me that this was not a pricing dispute situation, but that I needed to appeal to HCC insurance regarding this situation for an adjustment as this was a situation where I went to an in-network facility but had no choice in who I saw as a provider. They told me that they have had other patients appeal to their insurances to have the coverage adjusted to reflect this unique situation. I placed this appeal, and never got a clear answer from HCC aside from what was restated in their response to the Revdex.com: that the provider comes up in their system as "out of network" and I was charged the Usual, Reasonable, and Customary amount.I am not sure what HCC is referring to when they say, Our repricing department has reached out to the provider in attempt to negotiate a discount, and was unsuccessful." as I never got any communication of when this happened or the details of this, and none of the HCC representatives have ever told me this happened. I am confused, and frustrated that I am caught between an argument between HCC and [redacted]. I still do not think HCC is correctly acknowledging the circumstances of this visit, and my hunch is that [redacted] may be correct in this, but if they really think it is [redacted]'s issue, I would be willing to file a Revdex.com complaint on them also.
[redacted]
Please see the attached response to the following complaint: Complainant: [redacted], ID# [redacted]IN Revdex.com File #: [redacted]
Thank you, Lori L[redacted]
We ahve again reviewed the claims on file for Ms. [redacted]'s child. Ms. [redacted] states that the routine claims must be paid in full however, that is not correct. The benefits are subject to the policy holder's deductible and coinsunance. The claims have appropriately processed per the policy guidelines and applied to her deductible.If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life Insurance Company[redacted] - directll[redacted]@hccmis.com
All pending claims on file are awaiting information for processing. Once the requested information is received, we will continue review of the claims on file.Two additional claims have appropriately denied as they were incurred after the policy termination date.If I can be of further assistance,...
please let me know. Respectfully,Lori L[redacted]ParalegalHCC Life Insurance Companyll[redacted]@hccmis.com317/221-8013
We have reviewed the file for Mr. [redacted] Mr. [redacted] requested that his contract be cancelled and his payment rescinded. This has been processed. I hope this information will allow the Bureau to conclude the handling of this file. If Ican be of further assistance,please let me know. ...
Sincerely, 'Lori L[redacted]ParalegalHCC Life Insurance Company 317/221-8013 ll[redacted]@hccmis.com
HCCMIS has reviewed the claims submitted by [redacted]. After review, the claims related to the pregnancy are covered under the policy (subject to deductible and coinsurance). HCCMIS will process these and send out new Explanation of Benefits after they are repriced. Any previously...
denied pregnancy claims will be reprocessed as well. 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
After review of Mr. [redacted]'s claims, HCC Life Insurance Company did reach out to the provider who has refused the discount. On December 28, 2015 a new explanation of benefits was sent to Mr. [redacted] showing the updated processing of the claims in question,If I can be of further assistance, please let me know.Respectfully,Lori L[redacted]ParalegalHCC Life Insurance Company317/221-8013ll[redacted]@hccmis.com
HCCMIS has re-evaluated the claims submissions for Mr. [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 to repricing. Once the claim has...
returned from repricing, Mr. [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 P[redacted] HCC Medical Insurance Services
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. Thank you for your help in this matter.
Regards,
[redacted]
Regarding #2, coinsurance has already been waived. This is indicated on the Explanation of Benefit forms that are mailed to both the member and provider. If Mr. [redacted] has overpaid on coinsurance to the provider, he must seek a refund from the provider directly. HCCMIS does not reimburse for these overpayments by the member. Regarding deductible, below is how the deductible was applied. Claim # [redacted] Deductible - $80.34 USD Claim # [redacted] Deductible - $92.65 USD Claim # [redacted] Deductible - $208.32 USD (See attached EOB) Claim # [redacted] Deductible - $118.69 USD Claim # [redacted] Deductible - $0.00 USD (See attached EOB) Claim # [redacted] Deductible - $0.00 USD (See attached EOB) Claim # [redacted] Deductible - $0.00 USD (See attached EOB) As was indicated in the response regarding coinsurance, if Mr. [redacted] has overpaid the provider for the deductible, he must seek a refund from the provider directly. HCCMIS does not reimburse for these overpayments by the member. Lastly, for [redacted] , this was related to the other 6/17/15 claims that were denied pre-existing ([redacted] and [redacted]). Mr. [redacted] agreed these were not eligible in a prior response; therefore, no exception was made for this claim.
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.
A few weeks ago, I sent paperwork stating that HCC Medical Services should refund me the money I spent out of pocket. The claims aren't even on the website. I've attached those bills to this response so the Revdex.com and HCC Medical Services can see what bills I'm talking about. I received another notice from one of the hospitals I went to (From a Dr. [redacted] at the Peninsula Urology Center) and they are still awaiting payment from HCC Medical Services, and I would like to add this claim isn't even on the website, even though I sent it in AND gave them medical records from Dr. [redacted]'s office.I will RESEND my claims and give them one last time to resolve these issues. Thank you, Revdex.com for following up on this issue and look forward to a resolution to his problem.[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.
[Provide details of why you are not satisfied with this resolution.]
Regards,
[redacted]
We have reviewed Ms. [redacted] file and determined that she requested to cancel her policy after the 10 day free look period on her policy. Consequently, she is no longer eligible for a full refund of her premiums. I hope this information will allow the Bureau to conclude the handling of this...
file. If I can be of further assistance, please let me know. Respectfully, Brittani S[redacted] Compliance Assistant 770.693.6457 b[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.I think the cause of the misunderstanding is the 2/21 prescription bill. I've attached original doctor's prescription and the bill from pharmacy. You can see that the 2/21 prescription is for another person, not for me. Please let me know if you need further information.
Regards,
[redacted]
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr. [redacted]. Thank you
We have reviewed Ms. [redacted] file and issues in her complaint. Unfortunately, the services were excluded under her policy. Consequently, her claims were properly denied under the terms and conditions of her policy. If I can be of further assistance, please let me...
know.Sincerely, Brittani S[redacted]Compliance Assistant770.693.645[redacted]@hcclife.com
We have not received a request to cancel Ms. [redacted]'s plan. If this request was sent to a broker, we would be happy to refund any premiums taken after the request if the original request is forwarded to me directly at l[redacted]@hccmis.com. Additionally, we have cancelled the plan as of March 13,...
2016 and no future payments will be taken.
If I can be of further assistance, please let me know.
Respectfully,
Lori [redacted]
Paralegal
HCC Life Iinsurance company
317-221-8013
HCCMIS has reprocessed the claim as eligible. A new EOB and check will be mailed to the address on file in Nepal. 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
The claim was processed to the address provided by the insured. Address changes can only be initiated by the insured. If an address change is needed, please have the insured email me directly at j[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.
This complaint was filed against HCC regarding my emergency room visit that I made to [redacted] Center Emergency room in Colorado Springs, CO on December 4, 2015. To sum up the reason for my complaint, the [redacted] Center Emergency Room was listed as within HCC insurances covered network, which I verified before I went, and I also verified with their customer service agents after the fact. My complaint is regarding why, if I went to an in-network emergency room, I am being billed for an out-of-network emergency room provider. I have been told by both [redacted] Center and HCC that sometimes hospitals that may be within network contract with providers who are out of network. As a patient in the emergency room I have no choice which provider takes care of me. And thus I am asking, why is it fair to me that I am being billed for an out-of-network physician service when I went to an in-network emergency room? The response that HCC has provided the Revdex.com is the same response I have gotten before from their customer service agents--because in their system the provider comes up as "out of network." By this I can tell that they still don't understand the nature of my complaint. I understand that the provider is coming up as "out of network" in their system. My question is again, why am I being billed for an out of network physician service that took place in an "in network" emergency room where I could not choose my provider? I am also confused by the rest of HCC's response, that "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 June 3, 2016, in my confusion I called [redacted] Specialists who bills for the emergency room physicians for [redacted] hospital to inquire about my bill, and they told me that the amount they bill is the same for the service, independent of whether the provider is considered in network or out of network. It is the same charge, but why I am responsible for is determined by the insurance whether it is considered in or out of network. When I told them that HCC told me otherwise, I got a representative from HCC on the phone with [redacted], and they got in a dispute on the phone and were talking past one another. The HCC representative managed to pass the phone call on to the pricing dispute department, who conveniently were closed for the day. The [redacted] agent at this point told me that this was not a pricing dispute situation, but that I needed to appeal to HCC insurance regarding this situation for an adjustment as this was a situation where I went to an in-network facility but had no choice in who I saw as a provider. They told me that they have had other patients appeal to their insurances to have the coverage adjusted to reflect this unique situation. I placed this appeal, and never got a clear answer from HCC aside from what was restated in their response to the Revdex.com: that the provider comes up in their system as "out of network" and I was charged the Usual, Reasonable, and Customary amount.I am not sure what HCC is referring to when they say, Our repricing department has reached out to the provider in attempt to negotiate a discount, and was unsuccessful." as I never got any communication of when this happened or the details of this, and none of the HCC representatives have ever told me this happened. I am confused, and frustrated that I am caught between an argument between HCC and [redacted]. I still do not think HCC is correctly acknowledging the circumstances of this visit, and my hunch is that [redacted] may be correct in this, but if they really think it is [redacted]'s issue, I would be willing to file a Revdex.com complaint on them also.
[redacted]
Please see the attached response to the following complaint: Complainant: [redacted], ID# [redacted]IN Revdex.com File #: [redacted]
Thank you, Lori L[redacted]
We ahve again reviewed the claims on file for Ms. [redacted]'s child. Ms. [redacted] states that the routine claims must be paid in full however, that is not correct. The benefits are subject to the policy holder's deductible and coinsunance. The claims have appropriately processed per the policy guidelines and applied to her deductible.If I can be of further assistance, please let me know.Respectfully, Lori L[redacted]ParalegalHCC Life Insurance Company[redacted] - directll[redacted]@hccmis.com
Please see the attached response to the following complaint: RE: Complainant: [redacted] Insured: [redacted] ID# [redacted] ...
Revdex.com Id: [redacted] Thank you, Lori L[redacted]
All pending claims on file are awaiting information for processing. Once the requested information is received, we will continue review of the claims on file.Two additional claims have appropriately denied as they were incurred after the policy termination date.If I can be of further assistance,...
please let me know. Respectfully,Lori L[redacted]ParalegalHCC Life Insurance Companyll[redacted]@hccmis.com317/221-8013
We have reviewed the file for Mr. [redacted] Mr. [redacted] requested that his contract be cancelled and his payment rescinded. This has been processed. I hope this information will allow the Bureau to conclude the handling of this file. If Ican be of further assistance,please let me know. ...
Sincerely, 'Lori L[redacted]ParalegalHCC Life Insurance Company 317/221-8013 ll[redacted]@hccmis.com