Combined Life Insurance Company Of New York

To Whom It May Concern:We are responding to your email dated 09/15/2015 regarding file number [redacted]As [redacted]'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 you. We have contacted [redacted] by telephone and will mail our response directly to him. He should receive the letter within the next 5-10 business days.If we can be of further assistance, please contact us.Sincerely,Yolande M[redacted], 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 [redacted], and find that this resolution is satisfactory to me.  Regards, [redacted]

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]

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 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!

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]

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 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]

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