Boston Sportscar

I've had policies since the late 80's with Combined Life In March of salesman Zach [redacted] showed up at our home unannounced He explained he had a new policy that would cover everything in the policies I had at that time and more I would however have to keep the disability policy, but he said to cancel all the rest when the new policy was in effect When this problem came about I found out he had been terminated On October 6, I had hip surgeryI filed the claim expecting to receive $just as Mr [redacted] had explainedBut only received $The company is saying it's because it was inpatient surgery not outBut that's not how the policy was explained to meAfter several complaints I finally received a written reply from a Paul [redacted] explaining salesmen cannot change or adjust policiesThis was a total misrepresentation by the salesman and in my opinion the company should stand behind their salesmenIf you have any further questions please feel free to call me at [redacted] Thank you, [redacted]

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this does not resolve my complaint For your reference, details of the offer I reviewed appear below.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]Regards, [redacted]

October 12, THE Revdex.com UPSTATE NY ATTENTION: [redacted] , COMPLAINT HANDLER EXT RE: YOUR COMPLAINT: # [redacted] CONSUMER: VIRGINIE CALVAO Dear Ms [redacted] : Thank you for your follow up correspondence regarding your complaint # [redacted] , referenced above, and providing us with a copy of [redacted] ’s authorization to release information on this particular claim and the related complaint Per your request, attached please find a copy of [redacted] s policy which provides benefits for hospital confinement resulting from Injury or covered Sickness Also included are copies of the Spouse Rider, which adds [redacted] to the coverage, and the Outpatient Surgery Rider which provides benefits “if because of an Injury or a covered Sickness you require Outpatient Surgery” The attached Hospital bill documents an inpatient admission date of 4/6/and a discharge date of 4/10/15, with detail showing charges for days Room and Board The bill further documents charges for surgical services received while [redacted] was an inpatient Benefits were provided for hospital confinement with our check of 8/28/15, in accordance with the terms of [redacted] ’s coverage Our policyholder alleges that she was told that if she “had to have an emergency C-section that it was covered and it would pay a $2, benefit” However, as [redacted] was an inpatient in the Hospital at the time of her surgery, benefits would not be applicable under the terms of the Outpatient Surgery Rider [redacted] was advised of this with our letter of September 17, We also wish to advise that the Uniform Provisions of the policy state that “No agent may change this policy or waive any of its provisions” We trust this information satisfactorily addresses this inquiryIf we may be of further assistance, please let us know Sincerely, Maria S*** Combined Life Insurance Company of New York Consumer Service Investigations Direct: ###-###-#### Toll Free: ###-###-#### /Ext *** FAX: ###-###-#### Case # [redacted]

The Company's response is attached. We will write to Ms. [redacted] under separate cover regarding her policy. Dear Sir,Thank you for your February 29, 2016 correspondence regarding the inquiry your office received from policy holder [redacted] Our records indicate that Ms. [redacted] has an... employer paid policy with us for which she is not responsible for paying premiums. Under separate cover, we will write to Ms. [redacted] regarding her coverage.We trust this letter satisfies your inquiry, however, if additional assistance is needed, please feel free to contact us. Consumer Service

Business responding directly to consumer due to privacy issue additionally

This letter is being written in response to your letter of June 30, Privacy reasons prevent us from discussing the details associated with Ms*** claimHowever, we are able to state that our Claim Department has mailed a letter to her regarding her claim and our department mailed her a
letter regarding our Claim Department’s handling of her claimWe also addressed the other concerns she sharedFor the record, our Claim Department mailed their letter on July 7, Our department’s letter was mailed to her today, July 8, If you have any questions, please let us knowSincerely, Paul B***, Senior Coordinator Combined Life Insurance Company of New York Consumer Service Investigations Direct: *** *** *** *** *** *** * *** *** *** *** *** *** ***

To Whom It May Concern:We are responding to your email dated 09/15/regarding file number ***As *** ***'s inquiry with your Office is regarding a claim and his claim information is protected under the Health Insurance Portability and Accountability Act (HIPAA), we are unable to disclose
any information to youWe have contacted *** *** by telephone and will mail our response directly to himHe should receive the letter within the next 5-business days.If we can be of further assistance, please contact us.Sincerely,Yolande M***, Senior CoordinatorCombined Life Insurance of New York###-###-#### (office)###-###-#### (fax)###-###-#### (toll free)

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this does not resolve my complaint. For your reference, details of the offer I
reviewed appear below.I spoke with Sue this week and Combined Insurance did not settle on the cancer policy and or any of my husbands treatment
Regards,
*** ***

June 22, response to Complaint #***: In accordance with our Privacy Pledge as well as HIPAA (Health Insurance Portability and Accountability Act) regulations, it is our goal to protect all confidential policyholder information, including policy benefit information and
specifically claim information, while continuing to provide high quality service to our customers. As the disclosure of Ms***’s policy and claim information is strictly prohibited, we are unable to provide any further information to you at this timeHowever, be assured that this matter is currently being investigated and Ms*** will be contacted directly once our review is completeIf you have any questions, please let us knowSincerely, Tamara LF*, Senior Coordinator Combined Life Insurance Company of New York Consumer Service Investigations (toll free) *** *** ***

This letter is being provided in response to
your inquiry of March 8, 2017.Privacy concerns prevent us from discussing our
insured’s policy and/or claim with your officeHowever, we are providing a
written response directly to him via traditional mail.If you
have any questions, please let us know.Sincerely,Paul ***, Senior CoordinatorCombined Life Insurance Company of New YorkConsumer Service Investigations

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  Regards, [redacted]

I've had policies since the late 80's with Combined Life.  In March of 2014 salesman Zach [redacted] showed up at our home unannounced.  He explained he had a new policy that  would cover everything in the policies I had at that time and more.  I would however have to keep the...

disability policy, but he said to cancel all the rest when the new policy was in effect.  When this problem came about  I found out he had been terminated.  On October 6, 2016 I had hip surgery. I filed the claim expecting to receive $2165.00 just as Mr. [redacted] had explained. But only received $165.00. The company is saying it's because it was inpatient surgery not out. But that's not how the policy was explained to me. After several complaints I finally received a written reply from a Paul [redacted] explaining salesmen cannot change or adjust policies. This was a total misrepresentation by the salesman and in my opinion the company should stand behind their salesmen. If you have any further questions please feel free to call me at [redacted]                                                              Thank you,                                                                   [redacted]

In accordance with the Privacy Act it is our goal to protect all confidential policyholder information while continuing to provide high quality service to our customers.As the disclosure of Mr. [redacted]’ policy information is strictly prohibited, we are unable to provide any further information to you...

at this time. However, be assured that we have investigated the matter and have mailed our response directly to Mr. [redacted] on this date. If you have any questions, or if we may be of further assistance, please do not hesitate to contact us

Our response to your office is attached. We sent a separate response to the insured.This letter is being written in response to the inquiry we received from your office concerning [redacted] policy.While the situation he shared appears to be the result of a clerical error on our end, please ask...

him to accept our apologies for any concern or inconvenience he may have experienced. Both of his recent payments were applied to his policy. His policy has now been restored to its original status.Our Policyholder Services Department sent a letter to Mr. [redacted] to confirm the update and correction. By way of the same letter, they are offering him various payment options.While we trust that this letter satisfactorily responds to your inquiry, if you have any questions, or if we can be of further assistance, please let us know.Sincerely,

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and find that this resolution is satisfactory to me.  Regards, [redacted]
THIS RESOLUTION IS NOT SATISFACTORY IAM STILL IN THE SAME SITUATION NOTHING HAS BEEN DONE!MEANWHILE THIS COMPANY IS STILL TAKING MONEY OUT OF MY CHECK EVERY TWO WEEKS!

The Company's response is attached.  We will write to Ms. [redacted] under separate cover regarding her policy. Dear Sir,Thank you for your February 29, 2016 correspondence regarding the inquiry your office received from policy holder [redacted]Our records indicate that Ms. [redacted] has an...

employer paid policy with us for which she is not responsible for paying premiums. Under separate cover, we will write to Ms. [redacted] regarding her coverage.We trust this letter satisfies your inquiry, however, if additional assistance is needed, please feel free to contact us. Consumer Service

Revdex.com:I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  For your reference, details of the offer I reviewed appear below.[To assist us in bringing this matter to a close, we would like to know your view on the matter.]Regards,[redacted]

Business responding directly to consumer due to privacy issue.. Thank you.

Business responding directly to consumer due to privacy issue additionally.

October 12,
2015                      ...

                                        ...⇄                                                
           
THE
Revdex.com UPSTATE NY
ATTENTION:  [redacted], COMPLAINT HANDLER EXT 283
RE:       YOUR COMPLAINT:      #[redacted]       
            CONSUMER:                VIRGINIE
CALVAO                               
                       
Dear Ms.
[redacted]:
Thank you
for your follow up correspondence regarding your complaint #[redacted], referenced
above, and providing us with a copy of [redacted]’s authorization to release
information on this particular claim and the related complaint.
Per your request, attached please find a copy of [redacted]s policy which provides benefits for hospital confinement resulting
from Injury or covered Sickness.  Also included are copies of the Spouse
Rider, which adds [redacted] to the coverage, and the Outpatient Surgery
Rider which provides benefits “if because of an Injury or a covered Sickness
you require Outpatient Surgery”.  The attached Hospital bill documents an
inpatient admission date of 4/6/15 and a discharge date of 4/10/15, with detail
showing charges for 4 days Room and Board.  The bill further documents
charges for surgical services received while [redacted] was an inpatient. 
Benefits were provided for hospital confinement with our check of 8/28/15, in
accordance with the terms of [redacted]’s coverage.
Our policyholder alleges that she was told that if she “had
to have an emergency C-section that it was covered and it would pay a $2,000
benefit”.   However, as [redacted] was an inpatient in the Hospital
at the time of her surgery, benefits would not be applicable under the terms of
the Outpatient Surgery Rider.  [redacted] was advised of this with our
letter of September 17, 2015.  We also wish to advise that the Uniform
Provisions of the policy state that “No agent may change this policy or waive
any of its provisions”.  
We trust this information satisfactorily
addresses this inquiry. If we may be of further assistance, please let us
know.  
Sincerely,
               
Maria S[redacted] 
Combined Life Insurance Company of New York
Consumer Service Investigations
Direct: ###-###-####
Toll Free:
###-###-#### /Ext
[redacted]                
FAX: ###-###-####
Case #[redacted]