April 16th, 2015Dear Sir/Madam: On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documentsThis member submitted a medical claim for reimbursement on 01/05/which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainderAlthough the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount specified on the claimUnfortunately we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claimSince that time member submitted a residual claim which has been subsequently paidMember indicates that a call from a supervisor was requested; our records indicate a supervisor callback was requested on 01/09/and occurred the same day within minutes of the original call, to explain the denied portion of the claimIf you have any questions or would like additional information regarding this matter please feel free to reach out to us at ###-###-####, Sincerely, Julie M VP Client Services
April 23rd, 2015Dear Sir/Madam: On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documentsThis member submitted a Revdex.com complaint regarding claim handlingTo reiterate details a medical claim for reimbursement on 01/05/was submitted which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainderAlthough the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount Specified on the claimAs we explained previously, we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claimMember is rejecting the explanation regarding unnecessary denials provided above however it was further explained that since that time member submitted a residual claim which has been subsequently paidThere are no further claims outstanding to be considered nor remaining to be paidIf you have any questions or would like additional information regarding this matter please feel free to reach out to us at [redacted] Sincerely, Julie M VP Client Services
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
Complaint: [redacted]
I am rejecting this response because: After the first rejection, I was told to re-submit the claim to receive the additional $270.82 (I still had $500.00 of funds available). The bottom line is I still had funds available with receipts to back it up and they kept rejecting it after telling me to re-submit it and I would receive it.
Regards,
[redacted]
April 23rd, 2015Dear Sir/Madam:
On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documents.
This member submitted a Revdex.com complaint regarding claim handling. To reiterate details a medical claim for reimbursement on 01/05/15 was submitted which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainder. Although the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $1500.00. The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount Specified on the claim. As we explained previously, we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claim.
Member is rejecting the explanation regarding unnecessary denials provided above however it was further explained that since that time member submitted a residual claim which has been subsequently paid. There are no further claims outstanding to be considered nor remaining to be paid.
If you have any questions or would like additional information regarding this matter please feel free to reach out to us at [redacted].
Sincerely,
Julie M
VP Client Services
April 16th, 2015Dear Sir/Madam:
On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documents.
This member submitted a medical claim for...
reimbursement on 01/05/15 which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainder. Although the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $1500.00. The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount specified on the claim. Unfortunately we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claim. Since that time member submitted a residual claim which has been subsequently paid.
Member indicates that a call from a supervisor was requested; our records indicate a supervisor callback was requested on 01/09/15 and occurred the same day within 30 minutes of the original call, to explain the denied portion of the claim. If you have any questions or would like additional information regarding this matter please feel free to reach out to us at ###-###-####,
Sincerely,
Julie M.
VP Client Services
April 16th, 2015Dear Sir/Madam: On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documentsThis member submitted a medical claim for reimbursement on 01/05/which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainderAlthough the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount specified on the claimUnfortunately we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claimSince that time member submitted a residual claim which has been subsequently paidMember indicates that a call from a supervisor was requested; our records indicate a supervisor callback was requested on 01/09/and occurred the same day within minutes of the original call, to explain the denied portion of the claimIf you have any questions or would like additional information regarding this matter please feel free to reach out to us at ###-###-####, Sincerely, Julie M VP Client Services
April 23rd, 2015Dear Sir/Madam: On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documentsThis member submitted a Revdex.com complaint regarding claim handlingTo reiterate details a medical claim for reimbursement on 01/05/was submitted which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainderAlthough the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount Specified on the claimAs we explained previously, we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claimMember is rejecting the explanation regarding unnecessary denials provided above however it was further explained that since that time member submitted a residual claim which has been subsequently paidThere are no further claims outstanding to be considered nor remaining to be paidIf you have any questions or would like additional information regarding this matter please feel free to reach out to us at [redacted] Sincerely, Julie M VP Client Services
[To assist us in bringing this matter to a close, you must give us a reason why you are rejecting the response. If no reason is received your complaint will be closed Administratively Resolved]
Complaint: [redacted]
I am rejecting this response because: After the first rejection, I was told to re-submit the claim to receive the additional $270.82 (I still had $500.00 of funds available). The bottom line is I still had funds available with receipts to back it up and they kept rejecting it after telling me to re-submit it and I would receive it.
Regards,
[redacted]
April 23rd, 2015Dear Sir/Madam:
On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documents.
This member submitted a Revdex.com complaint regarding claim handling. To reiterate details a medical claim for reimbursement on 01/05/15 was submitted which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainder. Although the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $1500.00. The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount Specified on the claim. As we explained previously, we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claim.
Member is rejecting the explanation regarding unnecessary denials provided above however it was further explained that since that time member submitted a residual claim which has been subsequently paid. There are no further claims outstanding to be considered nor remaining to be paid.
If you have any questions or would like additional information regarding this matter please feel free to reach out to us at [redacted].
Sincerely,
Julie M
VP Client Services
April 16th, 2015Dear Sir/Madam:
On behalf of our clients Crosby Benefit System administers various employee benefit plans according to the terms and conditions required by the clients and their governing plan documents.
This member submitted a medical claim for...
reimbursement on 01/05/15 which was correctly handled to allocate the first portion of the claim ($500.00) to cover out of pocket deductible expenses and pay the remainder. Although the member's supporting documentation for the claim totaled $1780.42, on the actual claim form the member only submitted the claim for $1500.00. The member's complaint revolves around the fact that she wished her claim to be settled for the amount equal to the supporting documentation rather than the amount specified on the claim. Unfortunately we are obligated to pay only total amount submitted on the claim form providing sufficient documentation exists to support the claim. Since that time member submitted a residual claim which has been subsequently paid.
Member indicates that a call from a supervisor was requested; our records indicate a supervisor callback was requested on 01/09/15 and occurred the same day within 30 minutes of the original call, to explain the denied portion of the claim. If you have any questions or would like additional information regarding this matter please feel free to reach out to us at ###-###-####,
Sincerely,
Julie M.
VP Client Services