Ebix Health Administration Exchange, Inc.

Again, the response will issue to consumer by December 4, (this complaint has arrived during reduced work week, the Thanksgiving holiday). December 15, 2015Arizona Revdex.com Northern & Western Arizona Grove AvenuePrescott, AZ RE:Dear Ms***
In reply to the notification dated and received November 24, and our subsequent email exchange of Friday, December 11, 2015, regarding the above-captioned complainant ID, please be advised that the consumer has not executed a HIPAA release and authorization that names the Arizona Revdex.com as an authorized party to receive information as to the complainant’s insurance coverage.Therefore, please be generally advised of the timely issuance of insurance documents with schedule of benefits to its consumers for their use, information, and review prior to seeking care from a healthcare providerThe complaint has been investigated and a detailed response has issued via certified mail to the insured consumer.Please be advised that the information contained herein is meant to be responsive to your inquiry on behalf of the insuredIt is not meant to constitute or be construed as a waiver of any other defense available to the insuring carrierThe insuring carrier expressly reserves all rights to assert any provision, limitation, or defense provided for under the Policy and/or applicable law.If anything further is required, please contact usSincerely,Wendy P***Wendy P*** *** *** *** ***

VIA Revdex.com EMAIL- [email protected] 6, 2016Revdex.com Serving Central ATTN: Conciliation & Engagement Specialist Nlih StreetPhoenix, AZ 85014RE: Revdex.com Id # *** Dear Conciliation & Engagement Specialist:Reference is made to your
correspondence dated May 4, regarding the above.Thank you for sending this matter to our attentionPlease be advised we take these matters very seriousWe will contact the insured directly and resolve this matter accordingly.Kind Regards,

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below.IHC was asking for records, per Hopkins they were providedI offered to email all records myself to them, I offered to send them our primary EOB's all of themMs*** refusedPlease see dated email below The diagnosis codes on all the claims and all the notes reflect that my husband had pre-existing conditions that they will not coverI WAS TOLD THAT HE WOULD BE COVERED REGARDLESS OF PRE-EXISTING CONDITIONS, which was a lieThe company misrepresented themselves so get a saleThey flat out lied about coverage details I have sent this issue to the insurance commissioner as well here in VirginiaThe company has sales reps that intentionally lie just to make the sale. The ONLY way I will mark this as closed and resolved is when we receive a FULL refund of all the premiums paid to this horrible company.Regards,*** *** On Jul 7, 2015, at 2:PM, *** *** wrote:Please do not email the EOBs from 2014. I’m able to secure copies of those during my review of the complaint.The information you provided is helpful.I’ll continue my inquiries and will follwith you if I need an additional information.Otherwise I will forward the response and keep you posted.Thank you,*** ***SrLicensing & Compliance SpecialistIHC Carrier Solutions

[A default letter is provided here which indicates your acceptance of the business's response. If you wish, you may update it before sending it.]
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID *** and find that this resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved
Regards,
*** *** Addendum 06/072016: Contacting customer service today at ***0, I was told I would receive a full refund of my $within - days from 06/01/
If funds are credited to my account in this timeframe, accept the business responseIf the funds are not returned within said time I will refile my complaint

Please be informed that this complaint was received during a reduced work week (due to the Thanksgiving holiday)A response will issue to the consumer by December 4, Thank you

In reply to the follinquiry of *** *** (Mrs***), the below statements are submitted on behalf of *** *** *** *** *** ** *** *** *** *** ("Standard Security")According to our records *** *** secured a coverage under a short term medical expense insurance plan under a group policyIHC Health Solutions, Incis the third-party administrator ("TPA")IHC Carrier Solutions provides legal non-TPA management functions Mr***'s coverage was effective August 23, through March 11, 2015.Ms*** states that "IHC was asking for records, per Hopkins they were provided." Upon review of the account, to date the claims department has not yet received the requested recordsThe documents had not been received from *** *** Hospital (the "Hospital") where the medical records authorization release contained electronic signatures of the Insured, *** *** ("Mr***")However, the Hospital records would not be released to Standard Security as they did not accept electronic signaturesThe medical records service sent two authorization requests and left several messages but did not receive return medical records release authorization with "live signatures." Accordingly the records could not be obtained, preventing full and complete review of the claimsTherefore, the review of the claims submitted has been suspendedUpon receipt of the requested information, the account will be available for complete reviewMr***, was notified by correspondence dated May 19, of the suspended statusI respectfully declined receipt of the explanation of benefits (EOBs) as I am able to obtain the records internallyStandard Security suspended review of Mr*** 's claim for the reasons stated above.With regard to the conversation between Mrs*** and insurance agent *** *** the sole inquiry of Mrs*** as to pre-existing conditions related to blood pressure medicationMr*** addressed that inquiry and also informed her that there are or other questions; these questions relate to medical history of an applicantMr*** confirmed the email address to which he was sending the insurance quote and short term medical brochure for her review.Mrs*** confirmed receipt of the emailMr*** reminds Mrs*** to review the quote and brochure.The brochure provides that short term medical expense policy includes a pre-existing condition exclusion provisionAdditionally, the application for insurance states in the Acceptance and Acknowledgment section at Item F, above the electronic signature, "I understand that health insurance benefits are excluded for pre-existing conditions and this coverage will not pay benefits for a disease or physical condition that I now have or have had within years of my application for coverage."Towards the conclusion of the call Mr*** reminds that policy documentation would arrive via email and states that "you're gonna get copies of his insurance cards, everything right there.' The Certificate of Insurance advises the insured to READ THIS CERTIFICATE CAREFULLYThe Certificate conspicuously states on page 1:CERTIFICATE OF INSURANCE GROUP SHORT TERM MEDICAL EXPENSE INSURANCE10-DAY RIGHT TO RETURN THE CERTIFICATEIf for any reason you are not satisfied with this Certificate, you may return it to us within 10-days after you receive itWe will refund any premium paid and your coverage issued under the Group Policy will be deemed void, just as though the coverage had not been issued .The claims have been adjudicated fully, under the provisions of the insurance plan, as the medical records submission is not completed As the Insured, *** ***, or his representative, *** ***, have not submitted a duly executed release authorizing the Arizona Revdex.com ("AZ Revdex.com") as privileged to receive specific records related to the insurance contract copies will issue directly to the complainant.*** ***Compliance SpecialistLegal Department

Dear Dispute Resolution Consultant:This is in response, on behalf of Standard Security Life Insurance Company of New York (“Standard Security”), to your correspondence dated August 10, and received August 11, According to our records Ms*** purchased a group short term medical
expense insurance planThe non-employer group policyholder is the Communicating for America, Inc., (the “Association”)The group policy is sitused in Washington, D.Cand is underwritten by Standard SecurityThe group policy is individually marketed to members of the Association and each enrollee receives an individual Certificate of Insurance (“Certificate”) itemizing their benefits, terms and conditions of the group short term medical expense insurance planIHC Health Solutions, Incis the third-party administrator (“TPA”)IHC Carrier Solutions provides legal non-TPA management functionsMs*** coverage was effective December 1, Ms. *** is requesting assistance as to payment of her claims.Please be advised that Ms*** also submitted filing with the Arizona Department of InsuranceThe Arizona Department of Insurance informed Ms*** of the need to complete the insurance company’s appeal processMs*** has separately filed an appeal with the internal appeal department under cover of correspondence dated August 10, We similarly request that the Revdex.com allow for the completion of this process as well.Please be advised that the information contained herein is meant to be responsive to your inquiry on behalf of the insuredIt is not meant to constitute or be construed as a waiver of any other defense available to the insuring carrierThe insuring carrier expressly reserves all rights to assert any provision, limitation or defense provided for under the Policy and/or applicable law. Should you have any further questions, please contact this office

Dear MsMarin: In reply to the notification regarding the above-captioned complainant ID, please be advised that the consumer has not executed a HIPAA release and authorization that names the Revdex.com as an authorized party to receive information as to the complainant’s insurance
coverageTherefore, please be generally advised the consumer’s concern had been resolved by communication dated 12/06/sent to consumerHowever a more detailed response will issue directly to the consumer in tomorrow’s outgoing mailIf anything further is required, please contact us

Revdex.com:I have reviewed the response made by the business in reference to complaint ID ***, and have determined that this proposed action would not resolve my complaint For your reference, details of the offer I reviewed appear below.IHC was asking for records, per *** they were providedI offered to email all records myself to them, I offered to send them our primary EOB's all of themMs*** refusedPlease see dated email below The diagnosis codes on all the claims and all the notes reflect that my husband had pre-existing conditions that they will not coverI WAS TOLD THAT HE WOULD BE COVERED REGARDLESS OF PRE-EXISTING CONDITIONS, which was a lieThe company misrepresented themselves so get a saleThey flat out lied about coverage details I have sent this issue to the insurance commissioner as well here in VirginiaThe company has sales reps that intentionally lie just to make the sale. The ONLY way I will mark this as closed and resolved is when we receive a FULL refund of all the premiums paid to this horrible company.Regards,*** *** On Jul 7, 2015, at 2:PM, Wendy *** wrote:Please do not email the EOBs from 2014.I’m able to secure copies of those during my review of the complaint.The information you provided is helpful.I’ll continue my inquiries and will follwith you if I need an additional information.Otherwise I will forward the response and keep you posted.Thank you,*** ***SrLicensing & Compliance SpecialistIHC Carrier SolutionsMember of The IHC Group

VIA Revdex.com PORTAL Member of The IHC Group March 31, 2016Arizona Revdex.com Northern & Western Arizona Grove AvenuePrescott, AZ RE:Dear Dispute Resolution Consultant:In reply to the notification dated and received November 24, regarding the above-captioned
complainant ID, please be advised that the consumer has not executed a HIPAA release and authorization that names the Arizona Revdex.com as an authorized party to receive information as to the complainant’s insurance coverage.Therefore, please be generally advised that the premiums are billed and collected per the insurance products purchased by a consumerUpon completion of review and inquiry into the matters alleged a separate detailed response will issue directly to the consumer.Please be advised that the information contained herein is meant to be responsive to your inquiry on behalf of the insuredIt is not meant to constitute or be construed as a waiver of any other defense available to the insuring carrierThe insuring carrier expressly reserves all rights to assert any provision, limitation or defense provided for under the Policy and/or applicable law.If anything further is required, please contact usSincerely,Wendy P***Wendy P*** Compliance Specialist Legal DepartmentCc: Via Certified Mail *** ** *** *** ***
*** ** ***

I received your reply that it appears from consumer that this is not resolved.Yes, I'm fully aware of thatI refer you to the statements in the correspondence, that there is no HIPAA authorization on file to disclose consumer's insurance matters to Revdex.comI also stated that upon completion of the review into the inquiry a separate detailed response will be sent directly to MsMessick Respectfully yours,Wendy P***Compliance SpecialistLegal Department

April 21, 2017Revdex.comEMissouri AvePhoenix, AZ 85014-4585RE:Dear Dispute Resolution Consultant:In reply to the notification regarding the above-captioned complainant ID, please be advised that the consumer has not executed a HIPAA release and authorization that names the
Revdex.com as an authorized party to receive information as to the complainant’s insurance coverageTherefore, please be generally advised the consumer’s concern will be investigated and a detailed response has issued under cover of correspondence of today’s date directly to the consumer.If anything further is required, please contact usSincerely,Wendy P*** Compliance Specialist Legal Department

** *** *** ** *** *** *** *** *** *** ** *** *** *** ** *** *** *** *** *** ** *** *** ***
Revdex.com:
I have reviewed the response made by the business in reference to complaint ID ***, and find that this
resolution would be satisfactory to me. I will wait until for the business to perform this action and, if it does, will consider this complaint resolved
Regards,
*** ***

Dear Conciliation & Engagement Specialist:Reference is made to your correspondence dated May 25, regarding the above.Thank you for sending this matter to our attentionPlease be advised the company takes these matters very seriousCorrespondence has been sent to the complainant and
we intend to resolve this matter accordingly.Regards, Terri AM***

Please see the attached correspondence. Thank you

Please see attached correspondence.Be further advised, detailed reply issued directly to consumer being sent today's mail

In reply to the follow-up inquiry of [redacted] (Mrs. [redacted]), the below statements are submitted on behalf of Standard Security Life Insurance Company of New York, NAIC [redacted] ("Standard Security"). According to our records [redacted] secured a coverage under a short term medical expense insurance plan under a group policy. IHC Health Solutions, Inc. is the third-party administrator ("TPA"). IHC Carrier Solutions provides legal non-TPA management functions . Mr. [redacted] coverage was effective August 23, 2014 through March 11, 2015.Ms. [redacted] states that "IHC was asking for records, per [redacted] they were provided." Upon review of the account, to date the claims department has not yet received the requested records. The documents had not been received from Johns [redacted] Hospital (the "Hospital") where the medical records authorization release contained electronic signatures of the Insured, [redacted] ("Mr. [redacted]"). However, the Hospital records would not be released to Standard Security as they did not accept electronic signatures. The medical records service sent two authorization requests and left several messages but did not receive return medical records release authorization with "live signatures." Accordingly the records could not be obtained, preventing full and complete review of the claims. Therefore, the review of the claims submitted has been suspended. Upon receipt of the requested information, the account will be available for complete review. Mr. [redacted], was notified by correspondence dated May 19, 2015 of the suspended status. I respectfully declined receipt of the 57 explanation of benefits (EOBs) as I am able to obtain the records internally. Standard Security suspended review of Mr. [redacted] 's claim for the reasons stated above.With regard to the conversation between Mrs. [redacted] and insurance agent Joseph [redacted] the sole inquiry of Mrs. [redacted] as to pre-existing conditions related to blood pressure medication. Mr. [redacted] addressed that inquiry and also informed her that there are 5 or 6 other questions; these questions relate to medical history of an applicant. Mr. [redacted] confirmed the email address to which he was sending the insurance quote and short term medical brochure for her review.Mrs. [redacted] confirmed receipt of the email. Mr. [redacted] reminds Mrs. [redacted] to review the quote and brochure.The brochure provides that short term medical expense policy includes a pre-existing condition exclusion provision. Additionally, the application for insurance states in the Acceptance and Acknowledgment section at Item F, above the electronic signature, "I understand that health insurance benefits are excluded for pre-existing conditions and this coverage will not  pay benefits for a disease or physical condition that I now have or have had within 5 years of my application for coverage."Towards the conclusion of the call Mr. [redacted] reminds that policy documentation would arrive via email and states that "you're gonna get copies of his insurance cards, everything right there.' The Certificate of Insurance advises the insured to READ THIS CERTIFICATE CAREFULLY. The Certificate conspicuously states on page 1:CERTIFICATE OF INSURANCE GROUP SHORT TERM MEDICAL EXPENSE INSURANCE10-DAY RIGHT TO RETURN THE CERTIFICATEIf for any reason you are not satisfied with this Certificate, you may return it to us within 10-days after you receive it. We will refund any premium paid and your coverage issued under the GroupPolicy will be deemed void, just as though the coverage had not been issued .The claims have been adjudicated fully, under the provisions of the insurance plan, as the medical records submission is not completed . As the Insured, [redacted], or his representative, [redacted], have not submitted a duly executed release authorizing the Arizona Revdex.com ("AZ Revdex.com") as privileged to receive specific records related to the insurance contract copies will issue directly to the complainant.[redacted]Compliance SpecialistLegal Department

In regard to the above-captioned consumer complaint, this response is submitted on behalf of [redacted]. According to our records [redacted] secured a coverage under a short term medical expense insurance plan under a group policy. IHC Health Solutions, Inc. is the third-party administrator ("TPA"). IHC Carrier Solutions provides legal non-TPA management functions. Mr. [redacted]'s coverage was effective August 23, 2014 through March 11, 2015.Please be further advised that the claims referenced were suspended pending the completion of medical review, including reports from the [redacted] Hospital. Despite attempts, Insured did not supply the Hospital's requisite authorizations and thus delaying and ultimately preventing complete claims review per the terms of the Certificate.In consideration that the Insured has not provided a duly executed release and authorization naming the Revdex.com as privileged to receive further information related to its short term medical expense insurance plan, a detailed reply will issue directly to complainant-the Insured's spouse [redacted] Ann [redacted].Sincerely,[redacted]

Please be advised that the insurance carrier did contact Ms. [redacted] directly. The insurance company, Standard Security Life Insurance Company of New York (NAIC #[redacted]) issued correspondence to Ms. [redacted] on 5/11/16 requesting additional information to further investigate her concern.Please be advised that the insurance carrier called Ms. [redacted] and left a voicemail on today’s date. We will also send a follow-up email to insured for the documentation requested in the  correspondence dated 5/11/16 that was sent to insured.

Dear Ms. Marin: In reply to the notification regarding the above-captioned complainant ID, please be advised that the consumer has not executed a HIPAA release and authorization that names the Revdex.com as an authorized party to receive information as to the complainant’s insurance...

coverage. Therefore, please be generally advised the consumer’s concern had been resolved by communication dated 12/22/2016 sent to consumer. However a more detailed response will issue directly to the consumer in tomorrow’s outgoing mail. If anything further is required, please contact us.