We have reviewed Ms [redacted] file and issues in her complaintUnfortunately, the services were excluded under her policyConsequently, her claims were properly denied under the terms and conditions of her policyIf I can be of further assistance, please let me know.Sincerely, Brittani S [redacted] Compliance Assistant[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 filled out the release form for my medical records to be released to HCCThe 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 happenTherefore 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 eitherI also know that HCC was sent some medical records from my doctor's officeIf they received these records, have these records been reviewed and what was the outcome? Regards, [redacted]
Dear Ms***,Mr [redacted] was covered under our Visitor Secure policy which is issued on a non-admitted basis to [redacted] Group Insurance Trust out of [redacted] , Bermuda The insurance is underwritten by [redacted] , London and HCC Medical Insurance Services (HCCMIS) is the administrator Please note that the policy contains the below provision: “ELIGIBLE MEDICAL EXPENSES – OUTPATIENT BENEFITS Emergency room expenses, including charges for use of the emergency room itself and any supplies or other charges incurred during use of the emergency room for a covered Injury, even if Hospital confinement is not required, or for a covered Illness which results in hospitalization as Inpatient.” (boldness added) Ms [redacted] was treated in the emergency room on an outpatient bases for an illnessThe provider billed the claims with a diagnosis for enthesopathyConsequently, the claims appropriately denied per the above exclusion We have treated this complaint as an appealWe have overturned our decision and allowed the claimsThe claims will be paid at the fee schedule provided in the members plan I hope this information will allow the Bureau to conclude the handling of this file If I can be of any further assistance, please let me know.Sincerely,Lori L***Paralegal and Complaints Coordinator
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 meWe are confident HCC will honor its letter from 2-17-(sent thru the Revdex.com network) and pay the expenses for the emergency visit at [redacted] on 12-6- Regards, [redacted]
We have reviewed Ms [redacted] fileIt appears we are still waiting to receive medical records from Dr [redacted] * [redacted] Once we receive the necessary medical records, we can continue our investigationIf I can be of further assistance, please let me knowRespectfully, Brittani S [redacted] Compliance Assistant [redacted]
Revdex.com: I would like to find out when should I expect the reimbursement payment mail to my address? Could you ask them? Thank you Regards, [redacted] ***
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 StatesThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust,Hamilton BermudaThis 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,to March 31, Ms [redacted] was seen on March 4,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[redacted] 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/"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[redacted] 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: "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 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 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 years immediately preceding the Certificate Effective DateFor 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 fileIf 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-ll***@tmhcc.com
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 stayWe 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 ClaimThe following is considered to be Proof of Claim: A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments; and Original itemized bills from Physicians, Hospitals and other medical providers; and Original receipts for any expenses which have already been paid by or on behalf of the MemberThe Member shall have days beginning on the last day of the Certificate Period to submit Proof of Claim to UnderwritersSubsequent 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 fileIf I can be of any further assistance, please let me knowSincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-ll***@tmhcc.com
Ms [redacted] ,a citizen of India purchased internationaltravel coverage under our Atlas America ProgramThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by [redacted] and HCC Medical Insurance Services (HCCMIS} is the Coverholder and AdministratorThe policy number is [redacted] and the plan is active from September 28,to October 28, Ms [redacted] was taken to the Emergency Room via ambulance on October 21,2015.Please note the policy contains the following in regards to ambulance charges: "Local Ambulance Usual,Reasonable and Customary charges,when covered Illness or Injury results in hospitalization as Inpatient" Ms [redacted] was not admitted as inpatient into the hospitalConsequently,the ambulance claim was correctly denied as a non-covered service Please note that the policy contains the following in regards to emergency room services: "Emergency Room Co-payment- Claims incurred in U.S.or Canada -The Member shall be responsible for a $co-payment for each use of Emergency room for an Illness unless the Member is admitted to the HospitalThere will be no copayment for Emergency room treatment of an Injury." The claim for the emergency room services was approved and processed accordingly on December 14,The clam in question for $was for the physician charges while in the emergency room.This claim was appropriately denied pending a HCFA from the provider.We have still not received this form;however,an exception has been made and the claim has been approved and sent to apply innetwork discounts.Once completed,Ms[redacted] will receive an updated explanation of benefits showing the processing of the claim Ms [redacted] has a deductible of $1,as well as a copayment if not admitted into the hospital If I can be of further assistance,please let me knowRespectfully, Lori L [redacted] Paralegal HCC Life Insurance Company 317/221-l***@tmhcc.com
We have nothing to add to our previous responseThe medical records received from her providers indicate that her treatment in April is related to her claims incurred in September Based upon her effective date in July 2014, these claims were properly handledWhile 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 [redacted] @hcclife.com
HCCMIS has received one claim on 6/9/under certificate [redacted] for $3, This claim was processed as eligible on 7/17/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
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, BermudaThe 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 coinsuranceWe apologize for the delay and inconvenience encountered by Ms [redacted] .Ms [redacted] will receive new Explanation of Benefits shortlyIn 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 $ I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me 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 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 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-Ext ***, 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 MrCharles 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]
Please see the attached responseThank you, LoriMedical Insurance Services Group North Illinois Street, Suite 600, Indianapolis, IN, USA Tel: 317-262-Fax: 317-262-Toll Free: [email protected] hccmis.com August 31, Ms [redacted] *** Revdex.com N Delaware Street #Indianapolis, IN 46204-RE: Complaint ID: [redacted] Complainant: [redacted] Insured: Mr [redacted] and Ms [redacted] Dear Ms***: On February 3, Mr [redacted] and Ms [redacted] , citizens of India, purchased international travel coverage under our Atlas America ProgramThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by Lloyds, London and Tokio Marine HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and AdministratorThe policies were active from February 3, to July 24, With ID numbers [redacted] and [redacted] Please note the policies contain the following exclusion: Exclusion: “Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as here in defined, are excluded from this insurance, except charges resulting directly from an Acute Onset of Pre-existing Condition, as herein defined, are covered for all Members subject to the limits set forth in the Schedule of Benefits and Limits.” 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 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 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 years immediately preceding the Certificate Effective DateFor the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Preexisting Condition.” Definition: “Acute Onset of Pre-existing Condition: The term “Acute Onset of a Pre-Existing Condition(s)” shall mean a sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent careThe Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policyTreatment must be obtained within hours of the sudden and unexpected outbreak or recurrenceA Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute OnsetThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage.” (boldness added) Ms [redacted] was seen for an injury on May 7, To complete with processing, we requested medical recordshere on 7/30/The claims were approved on August 23, Ms [redacted] will receive an updated Explanation of Benefits within business daysMr [redacted] was seen on April 16, through May 26, To complete with processing those claims, we requested medical records from the servicing providerThose records were received on July 25, We are finalizing our review of the claims and Mr [redacted] will receive an explanation of benefits within business daysIf you need additional information, please let me knowSincerely, Lori *** Paralegal and Complaints Coordinator Tokio Marine HCC Medical Insurance Services Group 317/221-l***@tmhcc.com
We have reviewed Mr [redacted] fileIt appears we are still waiting to receive medical records from Mr [redacted] primary care physicianOnce 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
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.It is not possible for anyone to assume that the symptoms existed during application and fever can begin at any momentIn addition; when someone gets sick they don't run to the doctor right awayMr [redacted] was not aware that he was suffering the symptoms of Malaria hence he did not run to the ER right awayIts with reasonable certainty that I can say that not everyone runs to the ER when they get a fever or feel illUsually people take OTC medication to relieve the symptoms Regards, [redacted]
Please find HCC Life Insurance Company's response attachedThank you
Please find attached HCC Life Insurance Company's response to your inquiry regarding Mr [redacted] ***Thank you
Please find HCC Life Insurance Company's response to your inquiry regarding Ms [redacted] ***Thank you
We have reviewed Ms [redacted] file and issues in her complaintUnfortunately, the services were excluded under her policyConsequently, her claims were properly denied under the terms and conditions of her policyIf I can be of further assistance, please let me know.Sincerely, Brittani S [redacted] Compliance Assistant[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 filled out the release form for my medical records to be released to HCCThe 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 happenTherefore 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 eitherI also know that HCC was sent some medical records from my doctor's officeIf they received these records, have these records been reviewed and what was the outcome? Regards, [redacted]
Dear Ms***,Mr [redacted] was covered under our Visitor Secure policy which is issued on a non-admitted basis to [redacted] Group Insurance Trust out of [redacted] , Bermuda The insurance is underwritten by [redacted] , London and HCC Medical Insurance Services (HCCMIS) is the administrator Please note that the policy contains the below provision: “ELIGIBLE MEDICAL EXPENSES – OUTPATIENT BENEFITS Emergency room expenses, including charges for use of the emergency room itself and any supplies or other charges incurred during use of the emergency room for a covered Injury, even if Hospital confinement is not required, or for a covered Illness which results in hospitalization as Inpatient.” (boldness added) Ms [redacted] was treated in the emergency room on an outpatient bases for an illnessThe provider billed the claims with a diagnosis for enthesopathyConsequently, the claims appropriately denied per the above exclusion We have treated this complaint as an appealWe have overturned our decision and allowed the claimsThe claims will be paid at the fee schedule provided in the members plan I hope this information will allow the Bureau to conclude the handling of this file If I can be of any further assistance, please let me know.Sincerely,Lori L***Paralegal and Complaints Coordinator
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 meWe are confident HCC will honor its letter from 2-17-(sent thru the Revdex.com network) and pay the expenses for the emergency visit at [redacted] on 12-6- Regards, [redacted]
We have reviewed Ms [redacted] fileIt appears we are still waiting to receive medical records from Dr [redacted] * [redacted] Once we receive the necessary medical records, we can continue our investigationIf I can be of further assistance, please let me knowRespectfully, Brittani S [redacted] Compliance Assistant [redacted]
Revdex.com: I would like to find out when should I expect the reimbursement payment mail to my address? Could you ask them? Thank you Regards, [redacted] ***
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 StatesThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust,Hamilton BermudaThis 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,to March 31, Ms [redacted] was seen on March 4,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[redacted] 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/"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[redacted] 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: "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 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 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 years immediately preceding the Certificate Effective DateFor 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 fileIf 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-ll***@tmhcc.com
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 stayWe 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 ClaimThe following is considered to be Proof of Claim: A completed and signed Claimant’s Statement and Authorization form, together with any/all required attachments; and Original itemized bills from Physicians, Hospitals and other medical providers; and Original receipts for any expenses which have already been paid by or on behalf of the MemberThe Member shall have days beginning on the last day of the Certificate Period to submit Proof of Claim to UnderwritersSubsequent 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 fileIf I can be of any further assistance, please let me knowSincerely, Lori L*** Paralegal Tokio Marine HCC Medical Insurance Services Group 317/221-ll***@tmhcc.com
Ms [redacted] ,a citizen of India purchased internationaltravel coverage under our Atlas America ProgramThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by [redacted] and HCC Medical Insurance Services (HCCMIS} is the Coverholder and AdministratorThe policy number is [redacted] and the plan is active from September 28,to October 28, Ms [redacted] was taken to the Emergency Room via ambulance on October 21,2015.Please note the policy contains the following in regards to ambulance charges: "Local Ambulance Usual,Reasonable and Customary charges,when covered Illness or Injury results in hospitalization as Inpatient" Ms [redacted] was not admitted as inpatient into the hospitalConsequently,the ambulance claim was correctly denied as a non-covered service Please note that the policy contains the following in regards to emergency room services: "Emergency Room Co-payment- Claims incurred in U.S.or Canada -The Member shall be responsible for a $co-payment for each use of Emergency room for an Illness unless the Member is admitted to the HospitalThere will be no copayment for Emergency room treatment of an Injury." The claim for the emergency room services was approved and processed accordingly on December 14,The clam in question for $was for the physician charges while in the emergency room.This claim was appropriately denied pending a HCFA from the provider.We have still not received this form;however,an exception has been made and the claim has been approved and sent to apply innetwork discounts.Once completed,Ms[redacted] will receive an updated explanation of benefits showing the processing of the claim Ms [redacted] has a deductible of $1,as well as a copayment if not admitted into the hospital If I can be of further assistance,please let me knowRespectfully, Lori L [redacted] Paralegal HCC Life Insurance Company 317/221-l***@tmhcc.com
We have nothing to add to our previous responseThe medical records received from her providers indicate that her treatment in April is related to her claims incurred in September Based upon her effective date in July 2014, these claims were properly handledWhile 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 [redacted] @hcclife.com
HCCMIS has received one claim on 6/9/under certificate [redacted] for $3, This claim was processed as eligible on 7/17/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
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, BermudaThe 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 coinsuranceWe apologize for the delay and inconvenience encountered by Ms [redacted] .Ms [redacted] will receive new Explanation of Benefits shortlyIn 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 $ I hope this information will allow the Bureau to conclude the handling of this fileIf I can be of any further assistance, please let me 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 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 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-Ext ***, 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 MrCharles 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]
Please see the attached responseThank you, LoriMedical Insurance Services Group North Illinois Street, Suite 600, Indianapolis, IN, USA Tel: 317-262-Fax: 317-262-Toll Free: [email protected] hccmis.com August 31, Ms [redacted] *** Revdex.com N Delaware Street #Indianapolis, IN 46204-RE: Complaint ID: [redacted] Complainant: [redacted] Insured: Mr [redacted] and Ms [redacted] Dear Ms***: On February 3, Mr [redacted] and Ms [redacted] , citizens of India, purchased international travel coverage under our Atlas America ProgramThe Group Master Policy is issued to the Atlas/International Citizens Group Insurance Trust, Hamilton BermudaThis insurance is underwritten by Lloyds, London and Tokio Marine HCC Medical Insurance Services Group (TMHCCMIS) is the Coverholder and AdministratorThe policies were active from February 3, to July 24, With ID numbers [redacted] and [redacted] Please note the policies contain the following exclusion: Exclusion: “Pre-existing Conditions – Charges resulting directly or indirectly from any Pre-existing Condition, as here in defined, are excluded from this insurance, except charges resulting directly from an Acute Onset of Pre-existing Condition, as herein defined, are covered for all Members subject to the limits set forth in the Schedule of Benefits and Limits.” 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 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 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 years immediately preceding the Certificate Effective DateFor the purposes of the Complications of Pregnancy coverage offered hereunder, Pregnancy will not be included within the definition of a Preexisting Condition.” Definition: “Acute Onset of Pre-existing Condition: The term “Acute Onset of a Pre-Existing Condition(s)” shall mean a sudden and unexpected outbreak or recurrence of a Pre-existing Condition(s) which occurs spontaneously and without advance warning either in the form of Physician recommendations or symptoms, is of short duration, is rapidly progressive, and requires urgent careThe Acute Onset of a Pre-existing Condition(s) must occur after the effective date of the policyTreatment must be obtained within hours of the sudden and unexpected outbreak or recurrenceA Pre-existing Condition that is a chronic or congenital condition or that gradually becomes worse over time will not be considered Acute OnsetThis benefit does not include coverage for known, scheduled, required, or expected medical care, drugs or Treatments existent or necessary prior to the Effective Date of coverage.” (boldness added) Ms [redacted] was seen for an injury on May 7, To complete with processing, we requested medical recordshere on 7/30/The claims were approved on August 23, Ms [redacted] will receive an updated Explanation of Benefits within business daysMr [redacted] was seen on April 16, through May 26, To complete with processing those claims, we requested medical records from the servicing providerThose records were received on July 25, We are finalizing our review of the claims and Mr [redacted] will receive an explanation of benefits within business daysIf you need additional information, please let me knowSincerely, Lori *** Paralegal and Complaints Coordinator Tokio Marine HCC Medical Insurance Services Group 317/221-l***@tmhcc.com
We have reviewed Mr [redacted] fileIt appears we are still waiting to receive medical records from Mr [redacted] primary care physicianOnce 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
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.It is not possible for anyone to assume that the symptoms existed during application and fever can begin at any momentIn addition; when someone gets sick they don't run to the doctor right awayMr [redacted] was not aware that he was suffering the symptoms of Malaria hence he did not run to the ER right awayIts with reasonable certainty that I can say that not everyone runs to the ER when they get a fever or feel illUsually people take OTC medication to relieve the symptoms Regards, [redacted]