Please be advised that we received and reviewed the records necessary to process Mr [redacted] claimsMr [redacted] will receive a copy of his Explanation of Benefits after network repricing If I can be of further assistance, please let me know Respectfully, Brittani [redacted] ComplianceAssistant 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 The response did not address the issue of pre-certification 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 appliedClaim # [redacted] Deductible - $USD Claim # [redacted] Deductible - $USD Claim # [redacted] Deductible - $USD (See attached EOB) Claim # [redacted] Deductible - $USD Claim # [redacted] Deductible - $USD (See attached EOB) Claim # [redacted] Deductible - $USD (See attached EOB) Claim # [redacted] Deductible - $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/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:I will happily accept the offer made by HCCMIS, as long as all my medical bills pertaining to Eye Consultants, Allergy Consultant, Hemotology Consultant, Iron IV Transfusions, MRI, Blood Tests (as all were investigative) ordered by different consultants are paid in fullNot forgetting that I had a policy which had $deductibleI am studying full time, however, I will try my best to chase every doctor for my medical records to be provided to HCCMIS, this however is undue and uncalled for stress.Also, I want it to be noted by Revdex.com that this insurance was misold by way of misrepresentation by HCCMIS Agent who advised my mother that I will be FULLY COVERED even for UC This is the reason my mother purchased the insurance from HCCMIS as other Insurance providers were offering a month waiting period for pre-existing conditionsThis in my view is illegalSurprisingly I haven't received an apology or any form of compensation from HCCMIS, considering the harassment and immense stress they have caused by wrongfully denying my claims 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 My name is [redacted] ***I filed a complaint about Hcc medical insurance serviceThe ID is [redacted] And the business responded that they have already approved my claims and will update me the new explanation of benefits within ten days on April 7th Then the case closedBut these two days I kept receiving letters from them requesting the same documents written in the complaintWhen I called hccmis, they told me the very same thing as they told me beforeSo I supposed they didn't honestly process my claims as they said in the responseWhat should I do? Should I file another complaint? Thank you for helpBest 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 Hi,I would like to thank HCC for taking efforts to solve my problemsHowever, there are few more issues need to be address before we close the request.Documents attached.1) Third Party Claim Form - Mr [redacted] 2) Third Party Claim Form - Mrs [redacted] 3) Banner Health Bill for Mrs [redacted] showing deductibles and coinsurance paid ($1,USD)4) Policy document stating coinsurance clause and deductibles1) Mr [redacted] ( [redacted] )All issues are addressed by HCC; I have attached filled Third Party claim form that I already sent to HCC via email and through online athttps://zone.hccmis.com2) Mrs [redacted] ( [redacted] )I have attached and also send the Third Party Claim Form to HCC via email and through online (https://zone.hccmis.com)Claim # [redacted] - I have already paid deductibles as well as coinsuranceSo total amount, I paid is $1,USD ($USD Deductible + $1,USD Coinsurance 20% of $5,000USD)Pls find attached bill from Banner HealthSince, Banner Health comes in PPO network and as per policy, Coinsurance needs to be waivedThis mean I should reimburse this amount($1,USD - Third party form attached)Below is snippet from Policy document.Snippet -For the Certificate Period, Underwriters will pay 80% of the next $5,of Eligible Expenses after the Deductible, then 100% to the Overall Maximum LimitCoinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider.Moreover, Pharmacy Bill in connection with claims of pre-existing condition needs to reimburse meBelow is the claim detail for Pharmacy Bill.Claim # [redacted] (Pharmacy Bill) - USDSimilarly, I believe, since deductibles (USD) are already paid by me, below deductibles need to be taken care by HCC.Claim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USD Total Deductible - $USDI like to thanks again for providing resolution quickly.Thanks [redacted] Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID 10619350, and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below I have attached the documentation to support my denial of claimsHHC has consequently denied my claim based on pre-existing conditions, although this condition was not pre existingI have also filed a complaint with WV Insurance Commission and they have heard of this company doing similar thingsplease read attachments to get the full idea of the situationThanks Regards, Alexander Fatovic
Please see the attached response to the following complaint: RE: Complainant: [redacted] Insured: [redacted] ID# [redacted] ... BBB Id: [redacted] Thank you, Lori L***
Please be advised that we have made adjustments to two of Mr***' claimsHowever, other claims remain closed due to lack of informationAll dependent claims have been properly processed under the terms and conditions of his policyMr [redacted] may contact me if he has further concerns about outstanding information needed to process his claim Respectfuly, Lori L [redacted] Paralegal HCC Life Insurance Company [email protected] 317/221-
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 in months ago to have the pre-certificationThe associate told me I don't have to do anything thingI have phone conversation recordedPlease do a internal review of your customer serviceAt this stage, I am extremely frustrated Regards, [redacted] ***
I have provided Ms [redacted] with my direct number to reach me in the futureHCC Life Insurance Company has received the authorization completed by Ms [redacted] and forwarded it to the facility to release the requested medical recordsOnce medical records are returned, we will continue our review.If I can be of further assistance, please let me knowRespectfully, Lori LongParalegalHCC Life Insurance Company317/221-
We have reviewed Ms [redacted] file and determined that she requested to cancel her policy after the day free look period on her policyConsequently, she is no longer eligible for a full refund of her premiumsI hope this information will allow the Bureau to conclude the handling of this fileIf I can be of further assistance, please let me knowRespectfully, Brittani S [redacted] Compliance Assistant b [redacted] @hcclife.com
Ms [redacted] 's claims have now completed processing and an updated explanation of benefits was sent to both the policy holder and provider for each claim.If I can be of further assistance, please let me know.Respectfully, Lori L***ParalegalHCC Life Insurance Companyl***@hccmis.com317/221-
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]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID 11492964, and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below.This company is attempting to say that every single claim I've had is a result of my hearing loss (which I've had since I was born), and therefore not coveredThe issue that brought me into the doctor's office in the first place was headache and neck painBecause I do have hearing loss (even though unrelated), my doctor put hearing loss as one of my diagnosesIt is UNRELATED to the headache/neck pain that brought me into the officeIt is like saying someone's broken foot is a result of their hearing lossRidiculousThe first doctor I visited ordered an MRI and CT, an eye exam and blood workHe wanted to rule out any growths/tumors, etcthe MRI came back saying I have Chiari MalformationFollowing these results, the doctor sent me to a neurologist and a neurosurgeonThe neurosurgeon ordered another MRI (a different type) and the neurologist did some additional blood workThey did these to best decide how to treat me and my headaches and the ChiariHCC has chosen to deny all of these claims - the doctor visits, the blood work, every scanThey are still attempting to say 'condition not covered'First of all, we didn't even know what condition it was at first - which was the reason for the testsSecond of all, it has nothing to do with my hearing lossI have called multiple times and e-mailed and explained thisI filed my appeal in February and they had chosen to ignore it - until now after I filed an complaintNow they are asking for records and saying they will review my appealI know I'm not the only person they are doing this to - I've read the other complaintsI have one guy who has contacted me a few times since filing the complaint and he acts like he actually wants to helpSo I will send them my records, but I'm not holding my breathThe neurosurgeon wants to do surgery to alleviate the now daily neck/head pain I haveHowever, I can't even consider it until I am able to add to my husband's insurance and drop HCCI've already racked up almost $20k in bills that are being deniedLord knows how much this surgery would cost Regards, Samantha Dyer
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] ***
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me Regards, [redacted]
Please see the attached response in regards to the below complaint: RE: Complainant: [redacted] *** Policy Holder: [redacted] ID# [redacted] IN Revdex.com File #: [redacted] Thank you, Lori
After review of Mr [redacted] 's file, we have determined all claims have been appropriately applied to Mr [redacted] 's deductibleIt appears the medical provider is billing in excess of the discounted amount of the claimsOur repricing department is reaching out to the provider to discuss this issue.If I can be of further assistance, please let me know.Respectfully,Lori L***ParalegalHCC Life Insurance Company317/221-8013ll***@hccmis.com
Yes, both bills will be reprocessed
Please be advised that we received and reviewed the records necessary to process Mr [redacted] claimsMr [redacted] will receive a copy of his Explanation of Benefits after network repricing If I can be of further assistance, please let me know Respectfully, Brittani [redacted] ComplianceAssistant 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 The response did not address the issue of pre-certification 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 appliedClaim # [redacted] Deductible - $USD Claim # [redacted] Deductible - $USD Claim # [redacted] Deductible - $USD (See attached EOB) Claim # [redacted] Deductible - $USD Claim # [redacted] Deductible - $USD (See attached EOB) Claim # [redacted] Deductible - $USD (See attached EOB) Claim # [redacted] Deductible - $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/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:I will happily accept the offer made by HCCMIS, as long as all my medical bills pertaining to Eye Consultants, Allergy Consultant, Hemotology Consultant, Iron IV Transfusions, MRI, Blood Tests (as all were investigative) ordered by different consultants are paid in fullNot forgetting that I had a policy which had $deductibleI am studying full time, however, I will try my best to chase every doctor for my medical records to be provided to HCCMIS, this however is undue and uncalled for stress.Also, I want it to be noted by Revdex.com that this insurance was misold by way of misrepresentation by HCCMIS Agent who advised my mother that I will be FULLY COVERED even for UC This is the reason my mother purchased the insurance from HCCMIS as other Insurance providers were offering a month waiting period for pre-existing conditionsThis in my view is illegalSurprisingly I haven't received an apology or any form of compensation from HCCMIS, considering the harassment and immense stress they have caused by wrongfully denying my claims 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 My name is [redacted] ***I filed a complaint about Hcc medical insurance serviceThe ID is [redacted] And the business responded that they have already approved my claims and will update me the new explanation of benefits within ten days on April 7th Then the case closedBut these two days I kept receiving letters from them requesting the same documents written in the complaintWhen I called hccmis, they told me the very same thing as they told me beforeSo I supposed they didn't honestly process my claims as they said in the responseWhat should I do? Should I file another complaint? Thank you for helpBest 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 Hi,I would like to thank HCC for taking efforts to solve my problemsHowever, there are few more issues need to be address before we close the request.Documents attached.1) Third Party Claim Form - Mr [redacted] 2) Third Party Claim Form - Mrs [redacted] 3) Banner Health Bill for Mrs [redacted] showing deductibles and coinsurance paid ($1,USD)4) Policy document stating coinsurance clause and deductibles1) Mr [redacted] ( [redacted] )All issues are addressed by HCC; I have attached filled Third Party claim form that I already sent to HCC via email and through online athttps://zone.hccmis.com2) Mrs [redacted] ( [redacted] )I have attached and also send the Third Party Claim Form to HCC via email and through online (https://zone.hccmis.com)Claim # [redacted] - I have already paid deductibles as well as coinsuranceSo total amount, I paid is $1,USD ($USD Deductible + $1,USD Coinsurance 20% of $5,000USD)Pls find attached bill from Banner HealthSince, Banner Health comes in PPO network and as per policy, Coinsurance needs to be waivedThis mean I should reimburse this amount($1,USD - Third party form attached)Below is snippet from Policy document.Snippet -For the Certificate Period, Underwriters will pay 80% of the next $5,of Eligible Expenses after the Deductible, then 100% to the Overall Maximum LimitCoinsurance will be waived if expenses are incurred within the PPO and expenses are submitted to Underwriters for review and payment directly to the provider.Moreover, Pharmacy Bill in connection with claims of pre-existing condition needs to reimburse meBelow is the claim detail for Pharmacy Bill.Claim # [redacted] (Pharmacy Bill) - USDSimilarly, I believe, since deductibles (USD) are already paid by me, below deductibles need to be taken care by HCC.Claim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USDClaim # [redacted] Deductible - $USD Total Deductible - $USDI like to thanks again for providing resolution quickly.Thanks [redacted] Regards, [redacted]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID 10619350, and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below I have attached the documentation to support my denial of claimsHHC has consequently denied my claim based on pre-existing conditions, although this condition was not pre existingI have also filed a complaint with WV Insurance Commission and they have heard of this company doing similar thingsplease read attachments to get the full idea of the situationThanks Regards, Alexander Fatovic
Please see the attached response to the following complaint: RE: Complainant: [redacted] Insured: [redacted] ID# [redacted] ... BBB Id: [redacted] Thank you, Lori L***
Please be advised that we have made adjustments to two of Mr***' claimsHowever, other claims remain closed due to lack of informationAll dependent claims have been properly processed under the terms and conditions of his policyMr [redacted] may contact me if he has further concerns about outstanding information needed to process his claim Respectfuly, Lori L [redacted] Paralegal HCC Life Insurance Company [email protected] 317/221-
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 in months ago to have the pre-certificationThe associate told me I don't have to do anything thingI have phone conversation recordedPlease do a internal review of your customer serviceAt this stage, I am extremely frustrated Regards, [redacted] ***
I have provided Ms [redacted] with my direct number to reach me in the futureHCC Life Insurance Company has received the authorization completed by Ms [redacted] and forwarded it to the facility to release the requested medical recordsOnce medical records are returned, we will continue our review.If I can be of further assistance, please let me knowRespectfully, Lori LongParalegalHCC Life Insurance Company317/221-
We have reviewed Ms [redacted] file and determined that she requested to cancel her policy after the day free look period on her policyConsequently, she is no longer eligible for a full refund of her premiumsI hope this information will allow the Bureau to conclude the handling of this fileIf I can be of further assistance, please let me knowRespectfully, Brittani S [redacted] Compliance Assistant b [redacted] @hcclife.com
Ms [redacted] 's claims have now completed processing and an updated explanation of benefits was sent to both the policy holder and provider for each claim.If I can be of further assistance, please let me know.Respectfully, Lori L***ParalegalHCC Life Insurance Companyl***@hccmis.com317/221-
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]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID 11492964, and have determined that the response would not resolve my complaint For your reference, details of the offer I reviewed appear below.This company is attempting to say that every single claim I've had is a result of my hearing loss (which I've had since I was born), and therefore not coveredThe issue that brought me into the doctor's office in the first place was headache and neck painBecause I do have hearing loss (even though unrelated), my doctor put hearing loss as one of my diagnosesIt is UNRELATED to the headache/neck pain that brought me into the officeIt is like saying someone's broken foot is a result of their hearing lossRidiculousThe first doctor I visited ordered an MRI and CT, an eye exam and blood workHe wanted to rule out any growths/tumors, etcthe MRI came back saying I have Chiari MalformationFollowing these results, the doctor sent me to a neurologist and a neurosurgeonThe neurosurgeon ordered another MRI (a different type) and the neurologist did some additional blood workThey did these to best decide how to treat me and my headaches and the ChiariHCC has chosen to deny all of these claims - the doctor visits, the blood work, every scanThey are still attempting to say 'condition not covered'First of all, we didn't even know what condition it was at first - which was the reason for the testsSecond of all, it has nothing to do with my hearing lossI have called multiple times and e-mailed and explained thisI filed my appeal in February and they had chosen to ignore it - until now after I filed an complaintNow they are asking for records and saying they will review my appealI know I'm not the only person they are doing this to - I've read the other complaintsI have one guy who has contacted me a few times since filing the complaint and he acts like he actually wants to helpSo I will send them my records, but I'm not holding my breathThe neurosurgeon wants to do surgery to alleviate the now daily neck/head pain I haveHowever, I can't even consider it until I am able to add to my husband's insurance and drop HCCI've already racked up almost $20k in bills that are being deniedLord knows how much this surgery would cost Regards, Samantha Dyer
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] ***
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and find that this resolution would be satisfactory to me Regards, [redacted]
Please see the attached response in regards to the below complaint: RE: Complainant: [redacted] *** Policy Holder: [redacted] ID# [redacted] IN Revdex.com File #: [redacted] Thank you, Lori
After review of Mr [redacted] 's file, we have determined all claims have been appropriately applied to Mr [redacted] 's deductibleIt appears the medical provider is billing in excess of the discounted amount of the claimsOur repricing department is reaching out to the provider to discuss this issue.If I can be of further assistance, please let me know.Respectfully,Lori L***ParalegalHCC Life Insurance Company317/221-8013ll***@hccmis.com