[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 If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.] 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] ***
See attached documentEyeMed Vision CareQuality AssuranceLuxiottica PlaceMason, OH 45040Fax [email protected] Resolution [redacted] ***March 28, Reference ID: ***Thank you for your request received March 28, Your feedback is always important, and we’ve looked into the member’s request for reimbursement of the out of network contact lens servicesHere’s what we’ve determined:Case DetailsMember Name: [redacted] ***Plan Name: [redacted] Provider: [redacted] ***Inquiry Request: Member is requesting reimbursement for out of network contact lens services.Findings: According to the member’s benefits, the member is eligible to receive up to $for contact lenses purchase with an out of network providerThe $is a declining balance does not have to be used at one time but exhausted prior to the end of the calendar year in order for the member to not lose their allowanceThe allowance is reinstated on the first of January every year.The claim submitted for the December 27, service date was initially processed to reimburse the member $due to a system issueThe claim has since reprocessed reimbursing the member an additional $on March 17, maximizing the members out of network contact lens allowance of $105.The claim for the January 20, service date was submitted with a retail amount of $Due to a processing error both receipts were not applied and the member was reimbursed $The member’s claim will be forwarded for reprocessing to reimbruse the member an additional $The payment for the reprocessed claim can be expected in 10-business days.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at If you have any questions, call us at (or TDD at 866.308.5375), or visit www.eyemed.com.Sincerely,Nakia D [redacted] Quality Assurance Specialist
October 4, Reference [redacted] ***Thank you for your request received October 4, We've looked into the member's request for coverage of the contact lenses purchased with an out of network providerHere's what we've determined:Case Details [redacted] *** [redacted] Inquiry Request: Member is requesting reimbursement for the services received with an out of network provider.Findings: According to our records, the members plan was not active on the date the services were received rendering the member ineligible for reimbursement for the services received on July 14, If the member feels that coverage should be available for the date of service the member will need to speak with the Benefits Administrator through the employerOnce the eligibility has been received from the Benefits Administrator, the member can resubmit the out of network claim and itemized receipt for processing.You may receive, upon request, access to and copies of documents, records and other information relevant to your Complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at [redacted]
Good morning [redacted] ***EyeMed has listened to the call that [redacted] states she was told she by the call center that she would be allowed a new appeal window and that is not the caseThe member is not entitled to any further review The appeal process allows days from the date of EyeMed’s determination if a member disagrees [redacted] did not appeal within that time frame and is not entitled to an extended appeal periodWe consider the case closedThank you!Amy *S [redacted] | Corporate Legal |Eye Care and Regulatory Affairs |Senior Paralegal
[redacted] We have received the attached member complaintClaim # [redacted] was received on 1/24/and processed on 1/25/and paidA check was issued yesterday, 1/25/16, member should receive within 10-business daysMember DisbursementsClaim Amount$200.00Disbursement ID [redacted] Check Amount$200.00Check Date01/25/2017Void ReasonPayee [redacted] Disbursement Address [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 The response is not a resolution, merely an agreement to submit yet another claim in an attempt to correctly reimburse me for charges that the letter itself admits were validThe response will be acceptable to me once they have issued and mailed me a check with the correct amount, not merely a promise to restart a claim process that may or may not lead to such a check Regards, [redacted] ***
See attached documenteyeMed [redacted] direct dial 513-492-facsimile a [redacted] @luxotticaretail.com January 31, 2018VIA E-MAIL [redacted] @cincinnati.Revdex.com.org Revdex.com Attn: [redacted] E4th, Suite Cincinnati, OH 45202RE: Member: [redacted] ***Date(s) of Service: 1/10/Complaint Request: Member requesting reimbursement of $Revdex.com ID: [redacted] Dear [redacted] ***:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated January 24, regarding the above- referenced matter.In review of [redacted] ***’s account, EyeMed shows having received two email inquiries from [redacted] regarding claim statusA response to both inquiries was sent within less than business hours to [redacted] If he is not seeing those responses, he should check his junk and/or spam folders.EyeMed does not show having previously received a claim submission on [redacted] ***’s account in the last monthsHowever EyeMed is now in receipt of a claim submission sent directly to our Quality Assurance department received 01/29/via emailAs a one-time courtesy we have forwarded that claim documentation on his behalf to our Claims Department for processingPlease allow up to days to process your claim entirely once receivedYour claim will be processed in the order it is receivedA check and/or explanation of benefits will be mailed within calendar days of the date your claim is processed.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy ES [redacted] Senior Paralegal Corporate Legal DepartmentLuxottica Place, Mason, OH
The members complaint never once mentioned his wife, so we processed the complaint regarding the person who signed it, which was Ying Jiang, as there was no way to determine the complaint was regarding his wifeI have enclosed a copy of the complaint we receivedIn addition, both members have been reimbursed
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]
[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 If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.] 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] Message from Revdex.com: Consumer contacted the Revdex.com and indicated that this complaint has been closed
O3/8: : AM - OPAGE OF 3ATTN : [redacted] ***FROM : [redacted] DATE : March 06, SUBJECT :REF# ID [redacted] JOB: *** ATTACH: “Letter S ( ) .docx.” This Fax originated From a Bis com o Fax.com" MEMO: O3/8: : AM - OPAGE OF OF 3EyeMedVision eyeQuality Assurance MedLuxottica PlaceMason, OH 45040Fax513.492.3259Email [email protected] Resolution [redacted] *** MARKETPLACE RESOURCE CONSULTANT RE: [redacted] E.4TH, SUITE 600CINCINNATI, OH 452O2March 6, Reference ID: ***Thank you for your request received February 28, Your feedback is always important, and we've looked into your request regarding the member complaint you receivedHere's what we've determined:Case DetailsMember Name: [redacted] Plan Name: SRS VISION PLAN Date(s) of Service: 9/30/2016Findings: When visiting an out-of-network provider members are responsible for payment of services and/or materials at the time of service, EyeMed will reimburse the member for authorized services according to their plan designEyeMed will only accept itemized paid receipts that indicate the services provided and the amount charged for each serviceThe services must be paid in full in order to receive benefitsHandwritten receipts must be on the provider's letterheadThe EyeMed frame and lens benefit cannot be used for non-prescription sunglassesMembers cannot apply their frame benefit toward the purchase of a nsunglass frameAfter reviewing all submitted documentation including the member's out of network claim we've determined the member did not receive reimbursement for the original claim submitted because the frame purchase per the receipt submitted appears to have been sun wear with non-rxlenses which is not covered under the member's planThe member has resubmitted another claim for progressive lenses since the original claim denialThe member will be reimbursed for progressive lenses due to the member providing a receipt for progressive prescription lenses however the denial still stands for the frame since the receipt indicates the member purchased sun wear with nlenses.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your language, For help, call us at 888.338.5514.If you have any questions, call us at (or TDD at 866.308.5375), or visit www.eyemed.com O3/06/8: : AM - PAGE OF 3Sincerely, [redacted] Quality Assurance Specialist
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 I just contacted them again today to see where we stand and their protocol has not changedThey continue to provide information that does not match their previous claims and I still have not received my paymentThe claim/complaint has been forwarded to several supervisors/superiors to no availI have been told the check was in the mail three times, that a "check trace" would have to be done twice, that there was an an issue with my address/mailbox once, and many other storiesPlease let me know how many complaints have been filed against ***Thank you [redacted]
03/07/2017 12 : 09 : 08 PM - 05:00 PAGE 1. OF 3ATTN : [redacted] ***FROM : [redacted] ***DATE : March 0 7, 2017SUBJECT: REF [redacted] CASE ID [redacted] JOB: ***ATTACH: "Letters 1. docx."This Fax originated From a Biscom 'Fax.com' MEMO: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03/07/2017 12 : 09 : 08 PM - 05:00 PAE 2EyeMedVision Quality Assurance4000 Luxottica PLaceMason, OH 45040Fax [email protected] Resolution [redacted] MARKETPLACE RESOURCE CONSULTANTRE: [redacted] 1 E. 4TH ST. CINCINNATI, OH 45202March 7, 2017 Reference ID: ***Thank you for your request received March 7, 2017. Your feedback is always important, and we've looked into your request regarding the member complaint you received. Here's what we've determined:Case DetailsMember Name. [redacted] Plan Name: STATE VISION PLAN Claim Number: [redacted] Date(s) of Service. 2/4/2017Findings: When visiting an out-of-network provider, members are responsible for payment of services and/or materials at the time of service. EyeMed will reimburse members for authorized services according to their plan design. The member's vision plan offers a $130 in network declining balance allowance for contact lenses purchased from an in-network provider. There is a $104 out of network declining balance for contact lenses purchased from an out of network provider. After reviewing all submitted documentation we've confirmed the member's out of network claim processed correctly according to his plan design. The member can contact EyeMed customer service if they have further questions regarding their benefit coverage.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreter. Or you can have documents read to you and some sent to you in your language. For help, call us at 888.338.5514.If you have any questions, call us at 866.939.3633 (or TDD at 866.3085375), or visit www.eyemed.com.03/07/2017 12:09 PM -0500 PAGE 3 OF 3Sincerely, [redacted] Quality Assurance Specialist
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that the company has not resolved the issueI'm waiting for follow up, per their message Regards, [redacted] ***
The member's appeal will be forwarded to the EyeMed Legal Department for review with the plan uderwriter The resolution will be issued from either the Legal Department or the plan underwriterThank youEyeMed Quality AssuranceF: [email protected]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this service provider tries to find any excuse, and does not recognize their mishandling the complaint My complaint even didn't mention my wife, however, the reference number I provided does link to my wife's purchase.We did receive both reimbursements of myself and my wife's, because I called their complaint departmentRegards, [redacted] ***
Thank you for your request received October 14, Your feedback is always important, and we've looked into the members follow up to have the claim processed for reimbursementHere's what we've determined:Case Details [redacted] inquiry Request: Member is requesting reimbursement for services received with an out of network provider.Findings: Since the resolution issued on October 4, 2016, it appears that I provided the incorrect reason for the denial of the claimThe members claim denied due to missing itemized receipt for the purchaseUpon further review the members receipt was included with the claimWe apologize for this error and misinformation included in the initial responseAt this time the member's claim will be forwarded for processing towards the available benefits for the date of serviceit should be advised that the member will be reimbursed $as the benefit applies to contact lens materials and not shipping or processing applied by the providerPayment can be expected in 10-business days.You may receive, upon request, access to and copies of documents, records and other information relevant to your Complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your language, For help, call us at 883,338,5514.if you have any questions, call us at [redacted] (or TDD) at [redacted] ), or visit: [redacted] **.Sincerely, [redacted] Quality Assurance Specialist
Findings: The original claim form received from Dr [redacted] office denied due to missing/incomplete/invalid HCPCs/CPTsOnly routine vision services are covered under the members planThe denial was issued on July 27, and sent to the member's address on file as well as the provider's locationOur providers have days from the service date to submit a claim or file corrected claimsSome plans have shorter filing periodsWe recommend our provider's check the plan's claim filing period when they confirm benefits and eligibilityAll member requests for review must be submitted within days of the date of the explanation of benefitsOur records show our EyeMed customer service time forwarded the members claim for processing beyond timely filing limits as a one-time exceptionThe claim is now processed and payment was issued to the member's provider on April 25, The member was advised of the resolution via email on April 22, 2016.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at [redacted] .If you have any questions, call us at [redacted] Sincerely, [redacted] Quality Assurance Specialist
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.I find it absolutely ridiculous that they would say that my plan was not active on that dateMy plan allows for an eye exam and the purchase of contact lensesMy eye exam was aid for just days before, and all of a sudden I am no longer an active client? I should no longer have an EyeMed deduction on my paycheck if I am not activeFurther more, they have provided ZERO direct correspondence to me in any mannerNo phone calls, no emails, no direct mail contact attempts to explain any eligible lapse of coverageI have called their customer service numerous times and have receive a different excuse each timeThis is the first time I'm hearing about being covered, and it's a complete lieI just wonder if they even bother looking at the claim, or come up with a different excuse each time to avoid paying out of network claims.This company owes me a reimbursement for my contact lensI expect EyeMed to reimburse meThey have the proper paper workI have proof of the admission of the paper work, I have proof of the multiple contactsThese lies from this company are just pathetic Regards, [redacted] ***
[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 If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.] 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] ***
See attached documentEyeMed Vision CareQuality AssuranceLuxiottica PlaceMason, OH 45040Fax [email protected] Resolution [redacted] ***March 28, Reference ID: ***Thank you for your request received March 28, Your feedback is always important, and we’ve looked into the member’s request for reimbursement of the out of network contact lens servicesHere’s what we’ve determined:Case DetailsMember Name: [redacted] ***Plan Name: [redacted] Provider: [redacted] ***Inquiry Request: Member is requesting reimbursement for out of network contact lens services.Findings: According to the member’s benefits, the member is eligible to receive up to $for contact lenses purchase with an out of network providerThe $is a declining balance does not have to be used at one time but exhausted prior to the end of the calendar year in order for the member to not lose their allowanceThe allowance is reinstated on the first of January every year.The claim submitted for the December 27, service date was initially processed to reimburse the member $due to a system issueThe claim has since reprocessed reimbursing the member an additional $on March 17, maximizing the members out of network contact lens allowance of $105.The claim for the January 20, service date was submitted with a retail amount of $Due to a processing error both receipts were not applied and the member was reimbursed $The member’s claim will be forwarded for reprocessing to reimbruse the member an additional $The payment for the reprocessed claim can be expected in 10-business days.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at If you have any questions, call us at (or TDD at 866.308.5375), or visit www.eyemed.com.Sincerely,Nakia D [redacted] Quality Assurance Specialist
October 4, Reference [redacted] ***Thank you for your request received October 4, We've looked into the member's request for coverage of the contact lenses purchased with an out of network providerHere's what we've determined:Case Details [redacted] *** [redacted] Inquiry Request: Member is requesting reimbursement for the services received with an out of network provider.Findings: According to our records, the members plan was not active on the date the services were received rendering the member ineligible for reimbursement for the services received on July 14, If the member feels that coverage should be available for the date of service the member will need to speak with the Benefits Administrator through the employerOnce the eligibility has been received from the Benefits Administrator, the member can resubmit the out of network claim and itemized receipt for processing.You may receive, upon request, access to and copies of documents, records and other information relevant to your Complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at [redacted]
Good morning [redacted] ***EyeMed has listened to the call that [redacted] states she was told she by the call center that she would be allowed a new appeal window and that is not the caseThe member is not entitled to any further review The appeal process allows days from the date of EyeMed’s determination if a member disagrees [redacted] did not appeal within that time frame and is not entitled to an extended appeal periodWe consider the case closedThank you!Amy *S [redacted] | Corporate Legal |Eye Care and Regulatory Affairs |Senior Paralegal
[redacted] We have received the attached member complaintClaim # [redacted] was received on 1/24/and processed on 1/25/and paidA check was issued yesterday, 1/25/16, member should receive within 10-business daysMember DisbursementsClaim Amount$200.00Disbursement ID [redacted] Check Amount$200.00Check Date01/25/2017Void ReasonPayee [redacted] Disbursement Address [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 The response is not a resolution, merely an agreement to submit yet another claim in an attempt to correctly reimburse me for charges that the letter itself admits were validThe response will be acceptable to me once they have issued and mailed me a check with the correct amount, not merely a promise to restart a claim process that may or may not lead to such a check Regards, [redacted] ***
See attached documenteyeMed [redacted] direct dial 513-492-facsimile a [redacted] @luxotticaretail.com January 31, 2018VIA E-MAIL [redacted] @cincinnati.Revdex.com.org Revdex.com Attn: [redacted] E4th, Suite Cincinnati, OH 45202RE: Member: [redacted] ***Date(s) of Service: 1/10/Complaint Request: Member requesting reimbursement of $Revdex.com ID: [redacted] Dear [redacted] ***:EyeMed Vision Care, LLC (“EyeMed”) is in receipt of your letter dated January 24, regarding the above- referenced matter.In review of [redacted] ***’s account, EyeMed shows having received two email inquiries from [redacted] regarding claim statusA response to both inquiries was sent within less than business hours to [redacted] If he is not seeing those responses, he should check his junk and/or spam folders.EyeMed does not show having previously received a claim submission on [redacted] ***’s account in the last monthsHowever EyeMed is now in receipt of a claim submission sent directly to our Quality Assurance department received 01/29/via emailAs a one-time courtesy we have forwarded that claim documentation on his behalf to our Claims Department for processingPlease allow up to days to process your claim entirely once receivedYour claim will be processed in the order it is receivedA check and/or explanation of benefits will be mailed within calendar days of the date your claim is processed.Should you have any questions or concerns regarding this matter, please contact me directly.Sincerely,Amy ES [redacted] Senior Paralegal Corporate Legal DepartmentLuxottica Place, Mason, OH
The members complaint never once mentioned his wife, so we processed the complaint regarding the person who signed it, which was Ying Jiang, as there was no way to determine the complaint was regarding his wifeI have enclosed a copy of the complaint we receivedIn addition, both members have been reimbursed
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]
[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 If you and the business have reached an agreement and compliance is set for a future date, we trust the business will comply Please contact us after that time if the matter is not resolved as agreed and we will review the complaint and proceed accordingly.] 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] Message from Revdex.com: Consumer contacted the Revdex.com and indicated that this complaint has been closed
O3/8: : AM - OPAGE OF 3ATTN : [redacted] ***FROM : [redacted] DATE : March 06, SUBJECT :REF# ID [redacted] JOB: *** ATTACH: “Letter S ( ) .docx.” This Fax originated From a Bis com o Fax.com" MEMO: O3/8: : AM - OPAGE OF OF 3EyeMedVision eyeQuality Assurance MedLuxottica PlaceMason, OH 45040Fax513.492.3259Email [email protected] Resolution [redacted] *** MARKETPLACE RESOURCE CONSULTANT RE: [redacted] E.4TH, SUITE 600CINCINNATI, OH 452O2March 6, Reference ID: ***Thank you for your request received February 28, Your feedback is always important, and we've looked into your request regarding the member complaint you receivedHere's what we've determined:Case DetailsMember Name: [redacted] Plan Name: SRS VISION PLAN Date(s) of Service: 9/30/2016Findings: When visiting an out-of-network provider members are responsible for payment of services and/or materials at the time of service, EyeMed will reimburse the member for authorized services according to their plan designEyeMed will only accept itemized paid receipts that indicate the services provided and the amount charged for each serviceThe services must be paid in full in order to receive benefitsHandwritten receipts must be on the provider's letterheadThe EyeMed frame and lens benefit cannot be used for non-prescription sunglassesMembers cannot apply their frame benefit toward the purchase of a nsunglass frameAfter reviewing all submitted documentation including the member's out of network claim we've determined the member did not receive reimbursement for the original claim submitted because the frame purchase per the receipt submitted appears to have been sun wear with non-rxlenses which is not covered under the member's planThe member has resubmitted another claim for progressive lenses since the original claim denialThe member will be reimbursed for progressive lenses due to the member providing a receipt for progressive prescription lenses however the denial still stands for the frame since the receipt indicates the member purchased sun wear with nlenses.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your language, For help, call us at 888.338.5514.If you have any questions, call us at (or TDD at 866.308.5375), or visit www.eyemed.com O3/06/8: : AM - PAGE OF 3Sincerely, [redacted] Quality Assurance Specialist
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 I just contacted them again today to see where we stand and their protocol has not changedThey continue to provide information that does not match their previous claims and I still have not received my paymentThe claim/complaint has been forwarded to several supervisors/superiors to no availI have been told the check was in the mail three times, that a "check trace" would have to be done twice, that there was an an issue with my address/mailbox once, and many other storiesPlease let me know how many complaints have been filed against ***Thank you [redacted]
03/07/2017 12 : 09 : 08 PM - 05:00 PAGE 1. OF 3ATTN : [redacted] ***FROM : [redacted] ***DATE : March 0 7, 2017SUBJECT: REF [redacted] CASE ID [redacted] JOB: ***ATTACH: "Letters 1. docx."This Fax originated From a Biscom 'Fax.com' MEMO: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 03/07/2017 12 : 09 : 08 PM - 05:00 PAE 2EyeMedVision Quality Assurance4000 Luxottica PLaceMason, OH 45040Fax [email protected] Resolution [redacted] MARKETPLACE RESOURCE CONSULTANTRE: [redacted] 1 E. 4TH ST. CINCINNATI, OH 45202March 7, 2017 Reference ID: ***Thank you for your request received March 7, 2017. Your feedback is always important, and we've looked into your request regarding the member complaint you received. Here's what we've determined:Case DetailsMember Name. [redacted] Plan Name: STATE VISION PLAN Claim Number: [redacted] Date(s) of Service. 2/4/2017Findings: When visiting an out-of-network provider, members are responsible for payment of services and/or materials at the time of service. EyeMed will reimburse members for authorized services according to their plan design. The member's vision plan offers a $130 in network declining balance allowance for contact lenses purchased from an in-network provider. There is a $104 out of network declining balance for contact lenses purchased from an out of network provider. After reviewing all submitted documentation we've confirmed the member's out of network claim processed correctly according to his plan design. The member can contact EyeMed customer service if they have further questions regarding their benefit coverage.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreter. Or you can have documents read to you and some sent to you in your language. For help, call us at 888.338.5514.If you have any questions, call us at 866.939.3633 (or TDD at 866.3085375), or visit www.eyemed.com.03/07/2017 12:09 PM -0500 PAGE 3 OF 3Sincerely, [redacted] Quality Assurance Specialist
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that the company has not resolved the issueI'm waiting for follow up, per their message Regards, [redacted] ***
HelloPer EyeMed's contract with ***, the members complaint has been forwarded for resolutionThank you Nakia BlairEyeMed Quality Assurance Specialist
The member's appeal will be forwarded to the EyeMed Legal Department for review with the plan uderwriter The resolution will be issued from either the Legal Department or the plan underwriterThank youEyeMed Quality AssuranceF: [email protected]
Revdex.com: I have reviewed the response made by the business in reference to complaint ID [redacted] , and have determined that this service provider tries to find any excuse, and does not recognize their mishandling the complaint My complaint even didn't mention my wife, however, the reference number I provided does link to my wife's purchase.We did receive both reimbursements of myself and my wife's, because I called their complaint departmentRegards, [redacted] ***
Thank you for your request received October 14, Your feedback is always important, and we've looked into the members follow up to have the claim processed for reimbursementHere's what we've determined:Case Details [redacted] inquiry Request: Member is requesting reimbursement for services received with an out of network provider.Findings: Since the resolution issued on October 4, 2016, it appears that I provided the incorrect reason for the denial of the claimThe members claim denied due to missing itemized receipt for the purchaseUpon further review the members receipt was included with the claimWe apologize for this error and misinformation included in the initial responseAt this time the member's claim will be forwarded for processing towards the available benefits for the date of serviceit should be advised that the member will be reimbursed $as the benefit applies to contact lens materials and not shipping or processing applied by the providerPayment can be expected in 10-business days.You may receive, upon request, access to and copies of documents, records and other information relevant to your Complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your language, For help, call us at 883,338,5514.if you have any questions, call us at [redacted] (or TDD) at [redacted] ), or visit: [redacted] **.Sincerely, [redacted] Quality Assurance Specialist
Findings: The original claim form received from Dr [redacted] office denied due to missing/incomplete/invalid HCPCs/CPTsOnly routine vision services are covered under the members planThe denial was issued on July 27, and sent to the member's address on file as well as the provider's locationOur providers have days from the service date to submit a claim or file corrected claimsSome plans have shorter filing periodsWe recommend our provider's check the plan's claim filing period when they confirm benefits and eligibilityAll member requests for review must be submitted within days of the date of the explanation of benefitsOur records show our EyeMed customer service time forwarded the members claim for processing beyond timely filing limits as a one-time exceptionThe claim is now processed and payment was issued to the member's provider on April 25, The member was advised of the resolution via email on April 22, 2016.You may receive, upon request, access to and copies of documents, records and other information relevant to your complaint.Language Services: We provide no-cost language services, such as an interpreterOr you can have documents read to you and some sent to you in your languageFor help, call us at [redacted] .If you have any questions, call us at [redacted] Sincerely, [redacted] Quality Assurance Specialist
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.I find it absolutely ridiculous that they would say that my plan was not active on that dateMy plan allows for an eye exam and the purchase of contact lensesMy eye exam was aid for just days before, and all of a sudden I am no longer an active client? I should no longer have an EyeMed deduction on my paycheck if I am not activeFurther more, they have provided ZERO direct correspondence to me in any mannerNo phone calls, no emails, no direct mail contact attempts to explain any eligible lapse of coverageI have called their customer service numerous times and have receive a different excuse each timeThis is the first time I'm hearing about being covered, and it's a complete lieI just wonder if they even bother looking at the claim, or come up with a different excuse each time to avoid paying out of network claims.This company owes me a reimbursement for my contact lensI expect EyeMed to reimburse meThey have the proper paper workI have proof of the admission of the paper work, I have proof of the multiple contactsThese lies from this company are just pathetic Regards, [redacted] ***