Mr [redacted] 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 HCC Medical Insurance Services (HCCMIS) is the Coverholder and Administrator Mr [redacted] , a citizen of India, purchased coverage with an effective date of 5/11/and termination date of 5/28/for his travel outside India including the United States HCCMIS has previously received and responded to a Pennsylvania Department of Insurance complaint from Mr [redacted] regarding his claims denialAs explained in the Department of Insurance response, Mr [redacted] 's was treated on 5/19/and had surgery the same dayPer the medical records, the symptoms started one month priorBased on this, Mr [redacted] 's condition would be considered a preexisting condition under the policyPlease see the below definition and exclusions Exclusions: Pre-existing Conditions — Charges resulting directly or indirectly from any Pre-existing Condition, as herein 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 Definitions: 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 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 Preexisting 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 Additionally, per the above definition, the Acute Onset of Pre-existing Condition benefit excludes a preexisting condition that is a chronic or congenital condition or that gradually becomes worse over timeThe Acute Onset of Pre-existing Condition benefit also requires that 'treatment must be obtained within hours of the sudden and unexpected outbreak or recurrence'Per the Claimant's Statement and Authorization form, symptoms started on 5/17/and the medical records indicate that symptoms started month prior to being seen by the doctorIn either case, this would not be within the hour requirement of the onset of symptomsBecause of these reasons, Mr [redacted] is not eligible for the Acute Onset of Pre-existing Condition benefit 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, Jon [redacted] Vice President, Claims and Compliance 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 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, 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 factMy complaint is regarding why, if I went to an in-network emergency room, I am being billed for an out-of-network emergency room providerI have been told by both [redacted] Center and HCC that sometimes hospitals that may be within network contract with providers who are out of networkAs a patient in the emergency room I have no choice which provider takes care of meAnd 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 complaintI 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 providedOur 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 networkIt is the same charge, but why I am responsible for is determined by the insurance whether it is considered in or out of networkWhen 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 anotherThe HCC representative managed to pass the phone call on to the pricing dispute department, who conveniently were closed for the dayThe [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 providerThey told me that they have had other patients appeal to their insurances to have the coverage adjusted to reflect this unique situationI 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 happenedI 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] ***
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***'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 Have all the records for my claims been requested so that they can be reviewed? If not, which records still need to be requested? Have any of my claims been reviewed yet? If so, what is the status? Regards, [redacted]
Below are the responses to the latest questions:Regarding Claim # [redacted] - This claim did not take a deductible See attached EOB.In regards to [redacted] - The first claim form the insured sent was on 7/28/and indicated the 3rd week of June, see attached Because of this, we must rely on the first received information provided by the insured As was indicated in the prior responses, these claims were correctly denied under pre-existing exclusion
Please see the attached response in regards to the following complaint: RE: Complainant: [redacted] Policy Holder: [redacted] IN Revdex.com File #: [redacted] Thank you, Lori L***
Mrand Ms [redacted] were covered under our Atlas policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, Bermuda Coverage was purchased at 12:05pm on June 17th, with an effective date of the same day Several claims were submitted for Ms [redacted] Claims incurred on 6/17/were correctly denied under the pre-existing exclusion as symptoms (per the members claim form) existed prior to the purchase of the policy For claims incurred between 6/– 9/17, HCCMIS has requested medical records from Dr [redacted] Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy Regarding claims for Mr [redacted] , the routine exam claim was correctly denied as not covered under the plan For the remaining claims, HCCMIS has requested medical records from Dr*** Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy I hope this information will allow the Bureau to conclude the handling of this file If I can be of any further assistance, please let me know Sincerely, Jon P [redacted] HCC Medical Insurance Services
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 with Ms [redacted] that claims for eye/allergy were incorrectly denied and should be considered eligible for payment (subject to deductible and coinsurance) We will reprocess these claims immediately We apologize for the delay and inconvenience encountered by Ms [redacted] regarding the denial of these claims Ms [redacted] will receive new Explanation of Benefits for these reprocessed shortly For claims submitted for ulcerative colitis and anemia, these conditions were found to be pre-existing conditions based on the Claimant’s Statement and Authorization Form and the medical records received by HCCMIS Since pre-existing conditions are excluded under the policy, these claims were properly denied 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 Before going to the doctor I called the phone number specified on insurance card and informed about my health situationThe agent asked me to go to that particular medical centerSo since it's within your network I expect that you have agreement with the doctor about necessary paper workI don't have any control over communication between the doctor and HCCMoreover 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 payIf they don't pay the coverage then I expect that they will refund me full cost of insurance policy Regards, [redacted]
We have reviewed Mr [redacted] fileIt appears we are still waiting to receive medical records from Mr [redacted] physicianOnce we received this information, we can proceed to process his claimsIf we do not receive this information shortly, we will close our fileIf I can be of further assistance, please let me knowRespectfully, Brittani [redacted] Compliance Assistant b [redacted] @hcclife.com
Please be advised that the company we have also received an appeal by Ms [redacted] We will address her concern in our response to her appeal since it concerns her medical condition Her appeal is currently being processed and she will receive a determination from our appeals department once complete If I can be of further assistance, please let me know Respectfully, Brittani [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 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 have already paid off the provider and dont need any resolution from your end anymore as they had to send it to the collection agencyI just wanted to bring it to your notice that your staff had committed the mistakeThanks for following up and please make sure this doesnt get repeated 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 find the response by HCC quite confusingI am not sure what they mean when they say "HCC does not hold any contracts with the providerThe contract is between the network and the provider"All I know is that I checked HCC website to see which facilities were considered in network, and I went to a facility that was listed as "In network" on their website They also say "Mr***’s policy does not guarantee an innetwork provider" If this is true they should provide documentation that my policy holds me responsible for an out of network provider even if I went to a facility that was within network and saw a provider of which I did not have a choiceThey again have said " it has been determined that the claim on file has processed correctly." However, if this was the case from the very start, then why did they try negotiating for a discount? They must have known that something was amiss with this situationAs I stated in a previous response, the billing office for the emergency physician group said that charges for a visit are the same, but the patient financial responsibility depends on how the insurance processes it, whether it is considered in network or out of networkMy argument from the start is that if I went to an facility considered in network by HCC and saw a provider who I had no choice, then I should be responsible for the in network charges regardless of how the provider shows up in HCC's system.Again, as I have said in the previous response, I am happy to file a complaint with [redacted] Hospital or the [redacted] group if HCC thinks the burden lies with them Regards, [redacted] ***
Please find attached HCC Life Insurance Company's response to your inquiry regarding Ms [redacted] ***Thank you
Mr [redacted] 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 HCC Medical Insurance Services (HCCMIS) is the Coverholder and Administrator Mr [redacted] , a citizen of India, purchased coverage with an effective date of 5/11/and termination date of 5/28/for his travel outside India including the United States HCCMIS has previously received and responded to a Pennsylvania Department of Insurance complaint from Mr [redacted] regarding his claims denialAs explained in the Department of Insurance response, Mr [redacted] 's was treated on 5/19/and had surgery the same dayPer the medical records, the symptoms started one month priorBased on this, Mr [redacted] 's condition would be considered a preexisting condition under the policyPlease see the below definition and exclusions Exclusions: Pre-existing Conditions — Charges resulting directly or indirectly from any Pre-existing Condition, as herein 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 Definitions: 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 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 Preexisting 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 Additionally, per the above definition, the Acute Onset of Pre-existing Condition benefit excludes a preexisting condition that is a chronic or congenital condition or that gradually becomes worse over timeThe Acute Onset of Pre-existing Condition benefit also requires that 'treatment must be obtained within hours of the sudden and unexpected outbreak or recurrence'Per the Claimant's Statement and Authorization form, symptoms started on 5/17/and the medical records indicate that symptoms started month prior to being seen by the doctorIn either case, this would not be within the hour requirement of the onset of symptomsBecause of these reasons, Mr [redacted] is not eligible for the Acute Onset of Pre-existing Condition benefit 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, Jon [redacted] Vice President, Claims and Compliance 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 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, 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 factMy complaint is regarding why, if I went to an in-network emergency room, I am being billed for an out-of-network emergency room providerI have been told by both [redacted] Center and HCC that sometimes hospitals that may be within network contract with providers who are out of networkAs a patient in the emergency room I have no choice which provider takes care of meAnd 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 complaintI 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 providedOur 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 networkIt is the same charge, but why I am responsible for is determined by the insurance whether it is considered in or out of networkWhen 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 anotherThe HCC representative managed to pass the phone call on to the pricing dispute department, who conveniently were closed for the dayThe [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 providerThey told me that they have had other patients appeal to their insurances to have the coverage adjusted to reflect this unique situationI 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 happenedI 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 complaint number [redacted] filed by [redacted] in regards to [redacted] ***Thank you, Lori L***
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***'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] ***
Please see the attached response to the following complaint: RE: Complainant: [redacted] *** IN Revdex.com File #: [redacted] Thank you, Lori L***
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 Have all the records for my claims been requested so that they can be reviewed? If not, which records still need to be requested? Have any of my claims been reviewed yet? If so, what is the status? Regards, [redacted]
Please see the attached response to the following complaint: RE: Complainant: [redacted] ID number: [redacted] IN Revdex.com File #: [redacted]
Below are the responses to the latest questions:Regarding Claim # [redacted] - This claim did not take a deductible See attached EOB.In regards to [redacted] - The first claim form the insured sent was on 7/28/and indicated the 3rd week of June, see attached Because of this, we must rely on the first received information provided by the insured As was indicated in the prior responses, these claims were correctly denied under pre-existing exclusion
Please see the attached response in regards to the following complaint: RE: Complainant: [redacted] Policy Holder: [redacted] IN Revdex.com File #: [redacted] Thank you, Lori L***
Mrand Ms [redacted] were covered under our Atlas policy which is issued on a non-admitted basis to The Atlas/International Citizen Group Insurance Trust out of Hamilton, Bermuda Coverage was purchased at 12:05pm on June 17th, with an effective date of the same day Several claims were submitted for Ms [redacted] Claims incurred on 6/17/were correctly denied under the pre-existing exclusion as symptoms (per the members claim form) existed prior to the purchase of the policy For claims incurred between 6/– 9/17, HCCMIS has requested medical records from Dr [redacted] Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy Regarding claims for Mr [redacted] , the routine exam claim was correctly denied as not covered under the plan For the remaining claims, HCCMIS has requested medical records from Dr*** Once the medical records have been received, HCCMIS will determine if the claims are eligible under the policy I hope this information will allow the Bureau to conclude the handling of this file If I can be of any further assistance, please let me know Sincerely, Jon P [redacted] HCC Medical Insurance Services
Please 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 with Ms [redacted] that claims for eye/allergy were incorrectly denied and should be considered eligible for payment (subject to deductible and coinsurance) We will reprocess these claims immediately We apologize for the delay and inconvenience encountered by Ms [redacted] regarding the denial of these claims Ms [redacted] will receive new Explanation of Benefits for these reprocessed shortly For claims submitted for ulcerative colitis and anemia, these conditions were found to be pre-existing conditions based on the Claimant’s Statement and Authorization Form and the medical records received by HCCMIS Since pre-existing conditions are excluded under the policy, these claims were properly denied 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 Before going to the doctor I called the phone number specified on insurance card and informed about my health situationThe agent asked me to go to that particular medical centerSo since it's within your network I expect that you have agreement with the doctor about necessary paper workI don't have any control over communication between the doctor and HCCMoreover 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 payIf they don't pay the coverage then I expect that they will refund me full cost of insurance policy Regards, [redacted]
We have reviewed Mr [redacted] fileIt appears we are still waiting to receive medical records from Mr [redacted] physicianOnce we received this information, we can proceed to process his claimsIf we do not receive this information shortly, we will close our fileIf I can be of further assistance, please let me knowRespectfully, Brittani [redacted] Compliance Assistant b [redacted] @hcclife.com
Please be advised that the company we have also received an appeal by Ms [redacted] We will address her concern in our response to her appeal since it concerns her medical condition Her appeal is currently being processed and she will receive a determination from our appeals department once complete If I can be of further assistance, please let me know Respectfully, Brittani [redacted] Compliance Assistant [redacted] @hcclife.com
Please find HCC Life Insurance Company's response to your follow up inquiryThank 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 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 have already paid off the provider and dont need any resolution from your end anymore as they had to send it to the collection agencyI just wanted to bring it to your notice that your staff had committed the mistakeThanks for following up and please make sure this doesnt get repeated 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 find the response by HCC quite confusingI am not sure what they mean when they say "HCC does not hold any contracts with the providerThe contract is between the network and the provider"All I know is that I checked HCC website to see which facilities were considered in network, and I went to a facility that was listed as "In network" on their website They also say "Mr***’s policy does not guarantee an innetwork provider" If this is true they should provide documentation that my policy holds me responsible for an out of network provider even if I went to a facility that was within network and saw a provider of which I did not have a choiceThey again have said " it has been determined that the claim on file has processed correctly." However, if this was the case from the very start, then why did they try negotiating for a discount? They must have known that something was amiss with this situationAs I stated in a previous response, the billing office for the emergency physician group said that charges for a visit are the same, but the patient financial responsibility depends on how the insurance processes it, whether it is considered in network or out of networkMy argument from the start is that if I went to an facility considered in network by HCC and saw a provider who I had no choice, then I should be responsible for the in network charges regardless of how the provider shows up in HCC's system.Again, as I have said in the previous response, I am happy to file a complaint with [redacted] Hospital or the [redacted] group if HCC thinks the burden lies with them Regards, [redacted] ***